Organization Name: | JOSELO VICUNA MD LTD |
NPI Number: | 1235324369 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSELO A VICUNA (MEMBER) |
Mailing Address: | 2031 Mcdaniel St Suite 130 North Las Vegas |
State: | NV US |
Postal Code: | 890306303 |
Phone Number: | 7026493135 |
Fax Number: | |
NPI Enumeration Date: | 09/11/2007 |
NPI Last Update Date: | 12/07/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 3370 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NV |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |