Provider Demographics
NPI:1407139207
Name:COLINARES, KARNOVA
Entity Type:Individual
Prefix:
First Name:KARNOVA
Middle Name:
Last Name:COLINARES
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 1:7375 PRAIRIE FALCON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0810
Mailing Address - Country:US
Mailing Address - Phone:702-869-4401
Mailing Address - Fax:702-869-9904
Practice Address - Street 1:7375 PRAIRIE FALCON RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0810
Practice Address - Country:US
Practice Address - Phone:702-869-4401
Practice Address - Fax:702-869-9904
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017773171W00000X
NV2824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor