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General NPI Number Information
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NPI Number | 1043593296
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Entity Type | Organization
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Legal Business Name | ENRIQUE JOSE. LACAYO, M.D., LTD.
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 2010 GOLDRING AVE SUITE 302
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City | LAS VEGAS
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State | NV
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Zip | 89106-4002
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Country | US
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Telephone | 702-382-6970
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Fax | 702-382-9493
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Provider Business Mailing Address
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Address Line | 2010 GOLDRING AVE SUITE 302
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City | LAS VEGAS
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State | NV
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Zip | 89106-4002
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Country | US
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Telephone | 702-382-6970
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Fax | 702-382-9493
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. ENRIQUE JOSE LACAYO
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Credential | M.D.
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Telephone | 702-382-6970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 3199
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License Number State | NV
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