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General NPI Number Information
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NPI Number | 1326450511
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Entity Type | Organization
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Legal Business Name | AQUINO-VITALITY MEDICAL GROUP
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 3365 E FLAMINGO RD STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89121-6800
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Country | US
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Telephone | 702-457-3888
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Fax | 702-974-2199
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Provider Business Mailing Address
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Address Line | 3365 E FLAMINGO RD STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89121-6800
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Country | US
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Telephone | 702-457-3888
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Fax | 702-974-2199
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Authorized Official
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Title or Position | OWNER
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Name | RALPH AQUINO
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Credential | APRN
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Telephone | 702-457-3888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 001166
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License Number State | NV
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