Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 3370 | NV |
NPI | 1033201082 |
---|---|
Provider Name | Dr. Joselo Atienza Vicuna |
First Address | Las Vegas, NV 89193-8978 |
Second Address | North Las Vegas, NV 89030-7276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 25/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033201082 | (05) | NV |
C96664 | (02) |