Provider Demographics
NPI:1659885184
Name:RENATO OLEDAN RABARA FNP-C LLC
Entity type:Organization
Organization Name:RENATO OLEDAN RABARA FNP-C LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:OLEDAN
Authorized Official - Last Name:RABARA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-677-0661
Mailing Address - Street 1:9958 CORBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-3821
Mailing Address - Country:US
Mailing Address - Phone:702-677-0661
Mailing Address - Fax:702-854-9780
Practice Address - Street 1:9958 CORBRIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-3821
Practice Address - Country:US
Practice Address - Phone:702-677-0661
Practice Address - Fax:702-854-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty