MEDICARE: DR. SAMUEL ANTONIO MUJICA TRENCHE 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	208000000X	Pediatrics Physician	5456	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1366444937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL ANTONIO MUJICA TRENCHE MD

Provider Business Mailing Address
First Line	:	3265 ROSANNA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3137
Country	:	US
Telephone Number	:	702-205-1948
Fax Number	:	702-876-9181

Provider Business Practice Location Address
First Line	:	3265 ROSANNA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3137
Country	:	US
Telephone Number	:	702-205-1948
Fax Number	:	702-876-9181

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/17/2008

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