Provider Demographics
NPI:1972338457
Name:CARLOS, ISAIAH CEDRIC MABASA
Entity type:Individual
Prefix:
First Name:ISAIAH CEDRIC
Middle Name:MABASA
Last Name:CARLOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 ORIONS BELT PEAK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3741
Mailing Address - Country:US
Mailing Address - Phone:702-556-5958
Mailing Address - Fax:
Practice Address - Street 1:2950 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5209
Practice Address - Country:US
Practice Address - Phone:725-251-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV879544163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse