1790916575 NPI number — ROBERTO CORTEZ CARILLO JR. APN

Table of content: ROBERTO CORTEZ CARILLO JR. APN (NPI 1790916575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790916575 NPI number — ROBERTO CORTEZ CARILLO JR. APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARILLO
Provider First Name:
ROBERTO
Provider Middle Name:
CORTEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
APN
Provider Gender Code:
M

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:
1790916575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7373 PEAK DR
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-9003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-869-6190
Provider Business Mailing Address Fax Number:
702-869-6199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7373 PEAK DR
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-9003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-869-6190
Provider Business Practice Location Address Fax Number:
702-869-6199
Provider Enumeration Date:
07/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APN001126 , 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)





Copyright © 2007-2025 www.npivalidator.com