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NPI Code Detail

MEDICARE: CAMILO BERNAL TABORA JR. M.D.

MEDICARE: CAMILO BERNAL TABORA JR. M.D.
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
1207R00000XInternal Medicine Physician9691NV

Other Identifiers

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

General Provider Information

NPI Number : 1265543458
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILO BERNAL TABORA JR. M.D.
Provider Business Mailing Address
First Line : 3301 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1835
Country : US
Telephone Number : 702-968-0100
Fax Number : 702-968-0104
Provider Business Practice Location Address
First Line : 3301 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1835
Country : US
Telephone Number : 702-968-0100
Fax Number : 702-968-0104
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 06/07/2023

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Directions to “ CAMILO BERNAL TABORA JR. M.D.” Practice Location

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