MEDICARE: RAMON ALEX CONCEPCION RD, LD

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	133V00000X	Registered Dietitian	39012-DI-1	NV

General Provider Information

NPI Number	:	1831666148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMON ALEX CONCEPCION RD, LD

Provider Business Mailing Address
First Line	:	732 S 6TH ST # 6491
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	702-217-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 S 6TH ST # 6491
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	702-217-5220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2018
Last Update Date	:	01/28/2026

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