Healthcare Provider Details

I. General information

NPI: 1356438279
Provider Name (Legal Business Name): ERIC S CHINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY #560
LAS VEGAS NV
89128-0443
US

IV. Provider business mailing address

1930 VILLAGE CENTER CIR # 3-384A
LAS VEGAS NV
89134-6238
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-8346
  • Fax: 702-369-1903
Mailing address:
  • Phone: 702-233-8346
  • Fax: 702-369-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number5018
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: