MEDICARE: MARIO F. TARQUINO M.D. INC.

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
1	302F00000X	Exclusive Provider Organization		NV

General Provider Information

NPI Number	:	1659414654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO F. TARQUINO M.D. INC.

Provider Business Mailing Address
First Line	:	3230 E FLAMINGO RD # 334
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4320
Country	:	US
Telephone Number	:	702-454-8236
Fax Number	:	702-454-8279

Provider Business Practice Location Address
First Line	:	3230 E FLAMINGO RD # 334
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4320
Country	:	US
Telephone Number	:	702-454-8236
Fax Number	:	702-454-8279

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIO F. TARQUINO
Credential	:	M.D.
Telephone Number	:	702-454-8236

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/21/2022

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