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NPI Code Detail

MEDICARE: MARIO J. GASPAR DE ALBA M.D.

MEDICARE: MARIO J. GASPAR DE ALBA 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
12080P0006XDevelopmental - Behavioral Pediatrics PhysicianM3232TX
22080P0006XDevelopmental - Behavioral Pediatrics Physician14554NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3GW226ZOTHERNVMEDICARE

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
48H0437OTHERTXBC/BS OF TEXAS

General Provider Information

NPI Number : 1275546590
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIO J. GASPAR DE ALBA M.D.
Provider Business Mailing Address
First Line : 3016 W CHARLESTON BLVD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1973
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 630 S RANCHO DR STE A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4849
Country : US
Telephone Number : 702-998-9505
Fax Number : 702-527-7939
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 06/02/2020

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