Healthcare Provider Details

I. General information

NPI: 1669558284
Provider Name (Legal Business Name): MICHAEL R FALVO DO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 NEVADA HWY SUITE B
BOULDER CITY NV
89005-1853
US

IV. Provider business mailing address

1297 NEVADA HWY SUITE B
BOULDER CITY NV
89005-1853
US

V. Phone/Fax

Practice location:
  • Phone: 702-294-1919
  • Fax: 702-294-0072
Mailing address:
  • Phone: 702-294-1919
  • Fax: 702-294-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number697
License Number StateNV

VIII. Authorized Official

Name: MICHAEL RALPH FALVO
Title or Position: OWNER
Credential: MD
Phone: 702-294-1919