Provider Demographics
NPI:1396099339
Name:FLEMING, CONSUELOS
Entity type:Individual
Prefix:
First Name:CONSUELOS
Middle Name:
Last Name:FLEMING
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:PO BOX 5653
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-5653
Mailing Address - Country:US
Mailing Address - Phone:702-542-3250
Mailing Address - Fax:
Practice Address - Street 1:2491 E DEERSKIN ST
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-8134
Practice Address - Country:US
Practice Address - Phone:702-542-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner