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General NPI Number Information
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NPI Number | 1861756785
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Entity Type | Organization
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Legal Business Name | HOLY INFANT CARIN PEDIATRIC GROUP, PLLC
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 5120 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89120-1299
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Country | US
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Telephone | 702-234-7230
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Fax |
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Provider Business Mailing Address
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Address Line | 5120 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89120-1299
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER MEMBER
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Name | DR. MARIO CARIN
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Credential | MD
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Telephone | 702-234-7230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 10810
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License Number State | NV
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