Healthcare Provider Details

I. General information

NPI: 1205083847
Provider Name (Legal Business Name): ANGEL JESUS PANTALEON-MORALES CERT SURGICAL TECH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9499 W CHARLESTON BLVD SUITE 250
LAS VEGAS NV
89117-7147
US

IV. Provider business mailing address

9499 W CHARLESTON BLVD SUITE 250
LAS VEGAS NV
89117-7147
US

V. Phone/Fax

Practice location:
  • Phone: 702-933-3600
  • Fax: 702-933-3601
Mailing address:
  • Phone: 702-933-3600
  • Fax: 702-933-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number109344
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: