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General NPI Number Information
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NPI Number | 1235406463
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Entity Type | Organization
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Legal Business Name | DOMINIC RICCIARDI INC
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 8285 W ARBY AVE STE 165
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City | LAS VEGAS
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State | NV
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Zip | 89113-2239
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Country | US
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Telephone | 702-363-6005
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Fax |
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Provider Business Mailing Address
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Address Line | 8285 W ARBY AVE STE 165
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City | LAS VEGAS
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State | NV
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Zip | 89113-2239
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Country | US
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Telephone | 702-363-6005
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Fax |
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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 | 702-363-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 11899
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License Number State | NV
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