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NPI Code Detail

MEDICARE: KAREN BROTARLO BURGUILLOS PA

MEDICARE: KAREN BROTARLO BURGUILLOS PA
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 AssistantPA765NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255304523
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN BROTARLO BURGUILLOS PA
Provider Business Mailing Address
First Line : 10011 BLAIRWOOD CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89178-4830
Country : US
Telephone Number : 702-858-8615
Fax Number : 702-822-5001
Provider Business Practice Location Address
First Line : 4100 W FLAMINGO RD STE 2100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-3926
Country : US
Telephone Number : 702-822-5000
Fax Number : 702-822-5001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 01/12/2009

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Directions to “ KAREN BROTARLO BURGUILLOS PA” Practice Location

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