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NPI Code Detail

MEDICARE: DR. JESSIE M PICENO MD

MEDICARE: DR. JESSIE M PICENO MD
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
1207RN0300XNephrology Physician14024NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578602579
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSIE M PICENO MD
Provider Business Mailing Address
First Line : 2820 W CHARLESTON BLVD STE 33
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1934
Country : US
Telephone Number : 702-880-1558
Fax Number : 702-870-6821
Provider Business Practice Location Address
First Line : 2820 W CHARLESTON BLVD STE 33
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1934
Country : US
Telephone Number : 702-880-1558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 07/08/2020

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Directions to “ DR. JESSIE M PICENO MD” Practice Location

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