Provider Demographics
NPI:1639660657
Name:DALUGODA, KAUMADA RANGANISRI (CADC)
Entity Type:Individual
Prefix:
First Name:KAUMADA
Middle Name:RANGANISRI
Last Name:DALUGODA
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 SEVEN HILLS DR APT 1521
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4319
Mailing Address - Country:US
Mailing Address - Phone:702-797-0835
Mailing Address - Fax:
Practice Address - Street 1:2290 MCDANIEL ST # 1C
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6329
Practice Address - Country:US
Practice Address - Phone:702-399-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00757-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty