Provider Demographics
NPI:1497004857
Name:BANDA, KARLA ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:ELIZABETH
Last Name:BANDA
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 1:4754 EL TESORO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6811
Mailing Address - Country:US
Mailing Address - Phone:702-456-6909
Mailing Address - Fax:
Practice Address - Street 1:4754 EL TESORO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6811
Practice Address - Country:US
Practice Address - Phone:702-456-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor