REDENTOR BACANI (NPI# 1487725693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487725693 |
| Entity Type | Individual |
| Full Name | REDENTOR BACANI |
| Credential | PA-C |
| Practice Address |
4475 S Eastern Ave Las Vegas NV 89119-7826 |
| Mailing Address |
Po Box 15645 Las Vegas NV 89114-5645 |
| Practice Telephone | 7027371880 |
| Practice Fax Number | 7026505729 |
| Mailing Telephone | 7025602900 |
| Mailing Fax Number | 7025602928 |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2014-02-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
814 | NV | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | 1487725693 | 05 | |
| NV | RAILROAD MEDICARE | P01257618 | 01 |
| Street Address |
4475 S EASTERN AVE |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89119-7826 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245232750 | Paul Parcon | Family Medicine | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2005-08-15 |
| 1073114906 | Jacob A Parks | Student in an Organized Health Care Education/Training Program | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2020-11-06 |
| 1649871567 | Spencer Fleek | Student in an Organized Health Care Education/Training Program | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2020-11-06 |
| 1245831338 | Lauren Belove | Student in an Organized Health Care Education/Training Program | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2020-11-04 |
| 1396201414 | Robin Suzanne Branham | Nurse Practitioner | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2019-02-13 |
| 1558838136 | Daniel Thane Winward | Physician Assistant | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2018-10-31 |
| 1588189021 | Sandra Ramsey | Nurse Practitioner | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2017-08-05 |
| 1669996567 | Stacy Wayne Slade | Physician Assistant | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2017-08-01 |
| 1992236145 | Scarlett Cavalli | Family Medicine | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2017-03-21 |
| 1619418472 | Cameron Hunter | Physician Assistant | 4475 S Eastern Ave, Las Vegas, NV 89119-7826 | 2017-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669089298 | Jennifer Chavon Cruse | Technician | [email protected], 1775 East Tropicana Avenue 16-b, Las Vegas, NV 89119 | 2020-09-28 |
| 1063024214 | Rosa Isela Martinez Gonzalez | Technician | 4324 S. Eastern Ave. Ste. B, Las Vegas, NV 89119 | 2020-08-19 |
| 1720697980 | Christian Scott | Social Worker | 4055 Spencer St #118, Las Vegas, NV 89119 | 2020-07-23 |
| 1245867159 | Starfruit Holdings, LLC | Skilled Nursing Facility | 4375 S Eastern Ave, Paradise, NV 89119 | 2020-03-23 |
| 1215562376 | Phyllis Eberechukwu Hunt | Adult Companion | 5160 Tamarus St Appt 17, Las Vegas, NV 89119 | 2020-03-10 |
| 1841832581 | Legna Carrillo | Adult Companion | 4325 South Bruce St Appt 63, Las Vegas, NV 89119 | 2019-10-15 |
| 1104468339 | Alma Leticia Salazar | Home Health Aide | Safe At Home, LLC, 1775 E. Tropicana Ave. Suit 16-b, Las Vegas, NV 89119 | 2019-10-09 |
| 1083260046 | Araceli Rosas Vargas | Technician | 5160 S. Eastern Ave, Suite E, Las Vegas, NV 89119 | 2019-08-15 |
| 1376197707 | Bristure Clayton | Technician | Safe At Home LLC, 1775 E Tropicana Ave Ste 16, Las Vegas, NV 89119 | 2019-07-24 |
| 1457904534 | Carmen Laura Gonzalez Valenzuela | Chore Provider | 6725-1 S. Eastern Ave, Las Vegas, NV 89119 | 2019-07-18 |
| Find all providers in zip 89119 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821554106 | Amy Hamilton | Physician Assistant | 5785 Centennial Center Blvd Ste 190, Las Vegas, NV 89149-7110 | 2019-02-12 |
| 1386145159 | Kevin Refahiyat | Physician Assistant | 7150 S Durango Dr Ste 105, Las Vegas, NV 89113-2242 | 2018-02-26 |
| 1316487325 | Nadiya-larissa Bateman | Physician Assistant | 2809 W Charleston Blvd # 150, Las Vegas, NV 89102-1998 | 2017-02-24 |
| 1760840797 | Ying Quan | Physician Assistant | 2995 S Jones Blvd Ste A, Las Vegas, NV 89146-5612 | 2016-02-04 |
| 1396121646 | Lucas Michal Anderson | Physician Assistant | 9050 W Tropicana Ave, 1159, Las Vegas, NV 89147-8186 | 2015-08-09 |
| 1851631378 | Matthew Sanders | Physician Assistant | 6870 S. Rainbow Blvd, Suite 106, Las Vegas, NV 89118 | 2013-02-20 |
| 1285973289 | Jesus Angel Corn Sotelo | Physician Assistant | 4225 S Eastern Ave Ste 8, Las Vegas, NV 89119-5485 | 2013-02-11 |
| 1952675993 | Donald Patrick Mcgrorey Md Pllc | Physician Assistant | 6440 N Durango Dr Bldg A, Las Vegas, NV 89149-8513 | 2012-03-07 |
| 1508136375 | Leigh Richards Boeckle | Physician Assistant | 9033 W Sahara Ave, Las Vegas, NV 89117 | 2012-01-10 |
| 1225315229 | Samantha J Van Ginneken | Physician Assistant | 8020 S Rainbow Blvd Ste 100, Box #536, Las Vegas, NV 89139-6494 | 2011-11-04 |
| Find all providers in LAS VEGAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.