Healthcare Provider Details

I. General information

NPI: 1124906805
Provider Name (Legal Business Name): MR. ROBERTO MORENO PANGILINAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W CHARLESTON BLVD
LAS VEGAS NV
89102-1835
US

IV. Provider business mailing address

3301 W CHARLESTON BLVD
LAS VEGAS NV
89102-1835
US

V. Phone/Fax

Practice location:
  • Phone: 702-505-8225
  • Fax: 702-760-0965
Mailing address:
  • Phone: 702-505-8225
  • Fax: 702-760-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN27648
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: