Provider Demographics
NPI:1619682853
Name:PANDA MOVEMENT RECOVERY LLC
Entity Type:Organization
Organization Name:PANDA MOVEMENT RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MMP, FMT, CPT
Authorized Official - Phone:310-874-0408
Mailing Address - Street 1:8659 VERMONT VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-5540
Mailing Address - Country:US
Mailing Address - Phone:310-874-0408
Mailing Address - Fax:
Practice Address - Street 1:1820 S RAINBOW BLVD # 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2911
Practice Address - Country:US
Practice Address - Phone:310-874-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit