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NPI Code Detail

MEDICARE: PEDRO GINO PASSALACQUA

MEDICARE: PEDRO GINO PASSALACQUA
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
1103K00000XBehavior Analyst
2101Y00000XCounselor

General Provider Information

NPI Number : 1578991485
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEDRO GINO PASSALACQUA
Provider Business Mailing Address
First Line : 5575 SIMMONS ST
Second Line : 1-363
City : NORTH LAS VEGAS
State : NV
Zip : 89031-9009
Country : US
Telephone Number : 702-202-2567
Fax Number : 702-202-6919
Provider Business Practice Location Address
First Line : 3105 COLEMAN ST
Second Line : B
City : NORTH LAS VEGAS
State : NV
Zip : 89032-3807
Country : US
Telephone Number : 702-202-2567
Fax Number : 702-202-6919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2013
Last Update Date : 10/26/2015

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Directions to “ PEDRO GINO PASSALACQUA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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