MEDICARE: VIRGILIO SIU PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA934	NV

General Provider Information

NPI Number	:	1043241078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGILIO SIU PAC

Provider Business Mailing Address
First Line	:	8379 W SUNSET RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2243
Country	:	US
Telephone Number	:	725-200-3232
Fax Number	:	725-220-6389

Provider Business Practice Location Address
First Line	:	2354 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3451
Country	:	US
Telephone Number	:	702-476-2287
Fax Number	:	702-718-0393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	01/13/2023

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Directions to “ VIRGILIO SIU PAC” Practice Location

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