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NPI Code Detail

MEDICARE: DOMINIC RICCIARDI MD LTD

MEDICARE: DOMINIC RICCIARDI MD LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianNV20061204813NV

General Provider Information

NPI Number : 1023212552
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOMINIC RICCIARDI MD LTD
Provider Business Mailing Address
First Line : 6284 S RAINBOW BLVD
Second Line : SUITE 110
City : LAS VEGAS
State : NV
Zip : 89118-3244
Country : US
Telephone Number : 702-492-8281
Fax Number : 702-492-8279
Provider Business Practice Location Address
First Line : 8285 W ARBY AVE STE 145
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2236
Country : US
Telephone Number : 702-492-8281
Fax Number : 702-491-8279
Authorized Official
Title or Position : PRESIDENT
Name : DOMINIC RICCIARDI
Credential : MD
Telephone Number : 702-492-8281
Provider Enumeration Date : 06/11/2007
Last Update Date : 07/21/2022

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