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General NPI Number Information
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NPI Number | 1902265630
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Entity Type | Organization
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Legal Business Name | DEPALO LLC
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 6080 S FORT APACHE RD SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89148-5656
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Country | US
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Telephone | 520-903-7851
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Fax |
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Provider Business Mailing Address
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Address Line | 6080 S FORT APACHE RD SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89148-5656
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Country | US
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Telephone | 520-903-7851
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Fax |
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | CHRISTOPHER DEPALO
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Credential | D.O.
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Telephone | 520-903-7851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | DO-1810
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License Number State | NV
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