Provider Demographics
NPI:1023780996
Name:VITAL, KAHLEEN ANNE VINAS
Entity type:Individual
Prefix:
First Name:KAHLEEN ANNE
Middle Name:VINAS
Last Name:VITAL
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 1:2180 E WARM SPRINGS RD UNIT 2094
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0447
Mailing Address - Country:US
Mailing Address - Phone:702-742-6701
Mailing Address - Fax:
Practice Address - Street 1:2180 E WARM SPRINGS RD UNIT 2094
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0447
Practice Address - Country:US
Practice Address - Phone:702-742-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant