1043593296 NPI number — ENRIQUE JOSE. LACAYO, M.D., LTD.

Table of content: (NPI 1043593296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043593296 NPI number — ENRIQUE JOSE. LACAYO, M.D., LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENRIQUE JOSE. LACAYO, M.D., LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043593296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2010 GOLDRING AVE
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89106-4002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-382-6970
Provider Business Mailing Address Fax Number:
702-382-9493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2010 GOLDRING AVE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89106-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-382-6970
Provider Business Practice Location Address Fax Number:
702-382-9493
Provider Enumeration Date:
09/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LACAYO
Authorized Official First Name:
ENRIQUE
Authorized Official Middle Name:
JOSE
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
702-382-6970

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  3199 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89707 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002002214 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 275 . This is a "NEVADA CARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 102134004 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25647 . This is a "BLUE CROSS" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 2499444 . This is a "GHI" identifier . This identifiers is of the category "OTHER".




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