Provider Demographics
NPI:1851645345
Name:KHAL, FADA
Entity Type:Individual
Prefix:
First Name:FADA
Middle Name:
Last Name:KHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 SERENITY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2920
Mailing Address - Country:US
Mailing Address - Phone:702-287-3264
Mailing Address - Fax:
Practice Address - Street 1:2540 SERENITY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2920
Practice Address - Country:US
Practice Address - Phone:702-287-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker