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NPI Code Detail

MEDICARE: MITZILENE ANNE ALFONSO TUAZON MD

MEDICARE: MITZILENE ANNE ALFONSO TUAZON 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
1207Q00000XFamily Medicine Physician157598FL
2207QA0505XAdult Medicine Physician157598FL
3207Q00000XFamily Medicine Physician16533NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1SMA MEDICAREOTHERNVV114219

General Provider Information

NPI Number : 1528402351
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITZILENE ANNE ALFONSO TUAZON MD
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-877-5199
Fax Number :
Provider Business Practice Location Address
First Line : 4475 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-7826
Country : US
Telephone Number : 702-737-1880
Fax Number : 702-650-2458
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2013
Last Update Date : 11/19/2024

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