MEDICARE: ENRIQUE VILLALPANDO

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1922207042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE VILLALPANDO

Provider Business Mailing Address
First Line	:	800 N RAINBOW BLVD
Second Line	:	215
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1189
Country	:	US
Telephone Number	:	702-408-5862
Fax Number	:	702-948-7616

Provider Business Practice Location Address
First Line	:	800N RAINBOW BLVD STE 215
Second Line	:	OPTION 88 HEALTH SUPPLY
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1189
Country	:	US
Telephone Number	:	702-408-5862
Fax Number	:	702-948-7616

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

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Directions to “ ENRIQUE VILLALPANDO ” Practice Location

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