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NPI Code Detail

MEDICARE: VIRGILIO SIU PAC

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
1363AM0700XMedical Physician AssistantPA934NV

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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