=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891403952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LVSA ON CALL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2022
-----------------------------------------------------
Last Update Date | 11/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8930 W SUNSET RD STE 300
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-5013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-258-7788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8930 W SUNSET RD STE 300
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-5013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-258-7788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PHYSICIAN
-----------------------------------------------------
Name | PETER CARAVELLA
-----------------------------------------------------
Credential | MBR
-----------------------------------------------------
Telephone | 702-258-7788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------