Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003113077 |
---|---|
Provider Name | Mr. Luis Alberto Camargo |
First Address | Las Vegas, NV 89108-1862 |
Second Address | Las Vegas, NV 89102-1942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2011 |
Last Update Date | 27/02/2011 |