Provider Demographics
NPI:1629615059
Name:ABAD, JAMES MINER
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MINER
Last Name:ABAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 E PATRICK LN STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4902
Mailing Address - Country:US
Mailing Address - Phone:702-855-3382
Mailing Address - Fax:702-855-3384
Practice Address - Street 1:3960 E PATRICK LN STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4902
Practice Address - Country:US
Practice Address - Phone:702-855-3382
Practice Address - Fax:702-855-3384
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1192141244Medicaid