MEDICARE: MARIO JESUS LUGLIO

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	363LP2300X	Primary Care Nurse Practitioner	F08230345	NV

General Provider Information

NPI Number	:	1194504621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIO JESUS LUGLIO

Provider Business Mailing Address
First Line	:	1701 SERAFINA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4057
Country	:	US
Telephone Number	:	702-672-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 N TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1419
Country	:	US
Telephone Number	:	702-684-7800
Fax Number	:	702-684-7878

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

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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