Healthcare Provider Details

I. General information

NPI: 1922008523
Provider Name (Legal Business Name): RUCKDESCHEL MANNO, LTD. DBA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE BREAKTHROUGH WAY
LAS VEGAS NV
89135-3011
US

IV. Provider business mailing address

PO BOX 98809
LAS VEGAS NV
89193-8809
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-5433
  • Fax: 702-944-0471
Mailing address:
  • Phone: 702-822-5433
  • Fax: 702-944-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP MANNO
Title or Position: INTERIM DIRECTOR
Credential: M.D.
Phone: 702-822-5433