Provider Demographics
NPI:1710309992
Name:POINTER-KALLO, CHAQULA (DM-ODC, MA-HPS/EDU)
Entity Type:Individual
Prefix:DR
First Name:CHAQULA
Middle Name:
Last Name:POINTER-KALLO
Suffix:
Gender:F
Credentials:DM-ODC, MA-HPS/EDU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 AUTZEN STADIUM WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-1568
Mailing Address - Country:US
Mailing Address - Phone:662-573-2002
Mailing Address - Fax:
Practice Address - Street 1:3720 AUTZEN STADIUM WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-1568
Practice Address - Country:US
Practice Address - Phone:662-573-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No174400000XOther Service ProvidersSpecialist
No251S00000XAgenciesCommunity/Behavioral Health