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General NPI Number Information
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NPI Number | 1023212552
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Entity Type | Organization
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Legal Business Name | DOMINIC RICCIARDI MD LTD
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8285 W ARBY AVE STE 145
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City | LAS VEGAS
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State | NV
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Zip | 89113-2236
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Country | US
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Telephone | 702-492-8281
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Fax | 702-491-8279
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Provider Business Mailing Address
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Address Line | 6284 S RAINBOW BLVD SUITE 110
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City | LAS VEGAS
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State | NV
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Zip | 89118-3244
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Country | US
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Telephone | 702-492-8281
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Fax | 702-492-8279
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOMINIC RICCIARDI
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Credential | MD
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Telephone | 702-492-8281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | NV20061204813
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License Number State | NV
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