Provider Demographics
NPI:1043864457
Name:ALCANTARA, ROCHELLE FAITH GICAIN
Entity type:Individual
Prefix:MRS
First Name:ROCHELLE FAITH
Middle Name:GICAIN
Last Name:ALCANTARA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROCHELLE FAITH
Other - Middle Name:GICAIN
Other - Last Name:BAYLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5858 S PECOS RD # I-100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-5401
Mailing Address - Country:US
Mailing Address - Phone:702-855-3382
Mailing Address - Fax:702-855-3384
Practice Address - Street 1:5858 S PECOS RD # I-100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-5401
Practice Address - Country:US
Practice Address - Phone:702-855-3382
Practice Address - Fax:702-855-3384
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194121244Medicaid