MEDICARE: DR. BRIAN D VICUNA MD

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	207RX0202X	Medical Oncology Physician	12251	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12251	OTHER	NV	MD LICENSE

General Provider Information

NPI Number	:	1275755670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN D VICUNA MD

Provider Business Mailing Address
First Line	:	400 N STEPHANIE ST STE 300
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6692
Country	:	US
Telephone Number	:	702-952-3350
Fax Number	:	702-952-3365

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR STE 402
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0518
Country	:	US
Telephone Number	:	702-243-7200
Fax Number	:	702-243-7235

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	03/21/2024

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