Provider Demographics
NPI:1639556855
Name:KINAHAN, CONSUELO AUREA (BSCPHARM, MD)
Entity Type:Individual
Prefix:DR
First Name:CONSUELO
Middle Name:AUREA
Last Name:KINAHAN
Suffix:
Gender:F
Credentials:BSCPHARM, MD
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Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:5320 S RAINBOW BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-944-7105
Practice Address - Fax:702-944-7110
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV16677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV16677OtherSTATE LICENSE
NV1639556855Medicaid