Healthcare Provider Details

I. General information

NPI: 1962408179
Provider Name (Legal Business Name): VINCENT PETER NALBONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9111 W RUSSELL RD SUITE A
LAS VEGAS NV
89148-1245
US

IV. Provider business mailing address

9111 W RUSSELL RD SUITE 100
LAS VEGAS NV
89148-1245
US

V. Phone/Fax

Practice location:
  • Phone: 702-312-3333
  • Fax: 702-312-1144
Mailing address:
  • Phone: 702-312-3333
  • Fax: 702-312-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number8303
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: