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General NPI Number Information
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NPI Number | 1114056462
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Entity Type | Organization
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Legal Business Name | ROBERTO C CHUAPOCO MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 908 S VALLEY VIEW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89107-4412
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Country | US
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Telephone | 702-501-3500
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Fax | 702-988-7028
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Provider Business Mailing Address
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Address Line | 8608 MIRADA DEL SOL DR
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City | LAS VEGAS
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State | NV
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Zip | 89128-8206
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Country | US
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Telephone | 702-988-7028
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Fax | 702-988-7028
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERTO DE CASTRO CHUAPOCO JR.
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Credential | M.D.
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Telephone | 702-501-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 11482
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License Number State | NV
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