Provider Demographics
NPI:1528576402
Name:CANO, REMELA COLLADO
Entity Type:Individual
Prefix:
First Name:REMELA
Middle Name:COLLADO
Last Name:CANO
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 1:973 LEPORI WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1165
Mailing Address - Country:US
Mailing Address - Phone:775-355-3220
Mailing Address - Fax:775-355-3224
Practice Address - Street 1:973 LEPORI WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1165
Practice Address - Country:US
Practice Address - Phone:775-355-3220
Practice Address - Fax:775-355-3224
Is Sole Proprietor?:No
Enumeration Date:2018-01-13
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV372600000X
376G00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV820771184Medicaid