Provider Demographics
NPI:1205883642
Name:BASCHARON, RANDA AMIN (DO)
Entity type:Individual
Prefix:DR
First Name:RANDA
Middle Name:AMIN
Last Name:BASCHARON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 S RAINBOW #393
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103
Mailing Address - Country:US
Mailing Address - Phone:702-947-7790
Mailing Address - Fax:702-947-7792
Practice Address - Street 1:7281 W SAHARA AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2802
Practice Address - Country:US
Practice Address - Phone:702-947-7790
Practice Address - Fax:702-947-7792
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1103207X00000X, 207XX0005X
CA20A8358207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503044Medicaid
CAXTE006922OtherCALIF MEDI-CAL
NV100503044Medicaid
NV5771800006Medicare NSC
NV5771800004Medicare NSC
NVH87776Medicare UPIN
CA0250A8358Medicare ID - Type UnspecifiedCA MEDICARE
NV102677Medicare ID - Type UnspecifiedNV INDIVID PROV ID #
NV5771800005Medicare NSC