Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 16060 | NV |
N | 2080A0000X | Adolescent Medicine | 162398 | NY |
N | 208D00000X | General Practice Physician | 162398 | NY |
NPI | 1154548410 |
---|---|
Provider Name | Dr. Jose Rodriquez Simpao JR. |
First Address | Las Vegas, NV 89149-4596 |
Second Address | Las Vegas, NV 89149-4596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 17/03/2018 |