Healthcare Provider Details

I. General information

NPI: 1659414654
Provider Name (Legal Business Name): MARIO F. TARQUINO M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 E FLAMINGO RD # 334
LAS VEGAS NV
89121-4320
US

IV. Provider business mailing address

3230 E FLAMINGO RD # 334
LAS VEGAS NV
89121-4320
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-8236
  • Fax: 702-454-8279
Mailing address:
  • Phone: 702-454-8236
  • Fax: 702-454-8279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateNV

VIII. Authorized Official

Name: DR. MARIO F. TARQUINO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-454-8236