MEDICARE: EDUARDO DELATORRE CSFA

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	246ZC0007X	Surgical Assistant	162335	NV
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1427591759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO DELATORRE CSFA

Provider Business Mailing Address
First Line	:	7978 CORONADO COAST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6192
Country	:	US
Telephone Number	:	702-876-4333
Fax Number	:

Provider Business Practice Location Address
First Line	:	7978 CORONADO COAST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6192
Country	:	US
Telephone Number	:	702-876-4333
Fax Number	:

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

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	11/17/2016

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