Provider Demographics
NPI:1225538556
Name:CACACHO, FELICIDAD C
Entity Type:Individual
Prefix:
First Name:FELICIDAD
Middle Name:C
Last Name:CACACHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 W FLAMINGO RD STE 25
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3707
Mailing Address - Country:US
Mailing Address - Phone:702-871-9917
Mailing Address - Fax:702-871-9918
Practice Address - Street 1:4850 W FLAMINGO RD STE 25
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3707
Practice Address - Country:US
Practice Address - Phone:702-871-9918
Practice Address - Fax:702-871-9918
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty