Provider Demographics
NPI:1235521709
Name:RICAMONA, KESHIA (CST)
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:
Last Name:RICAMONA
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10561 JEFFREYS ST
Mailing Address - Street 2:STE 230
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4266
Mailing Address - Country:US
Mailing Address - Phone:702-565-6565
Mailing Address - Fax:702-990-5255
Practice Address - Street 1:10561 JEFFREYS ST
Practice Address - Street 2:STE 230
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4266
Practice Address - Country:US
Practice Address - Phone:702-565-6565
Practice Address - Fax:702-990-5255
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV152172246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV152172OtherNBSTSA