| Doctor Name: | DR. MYLENE B VICUNA |
| NPI Number: | 1457577827 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 125048180 |
| Business Practice Address: | 6857 W Charleston Blvd Las Vegas, NV - 891171600 |
| Business Phone Number: | 7023042144 |
| Business Fax Number: | 7023042147 |
| Mailing Address: | Po Box 15645, LAS VEGAS |
| State: | NV |
| Postal Code: | 891145645 |
| Phone Number: | 7025602886 |
| Fax Number: | 7025602928 |
| NPI Enumeration Date: | 04/17/2007 |
| NPI Last Update Date: | 02/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 125048180 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |