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NPI Code Detail

MEDICARE: SILVER STATE CARDIOLOGY, LLC

MEDICARE: SILVER STATE CARDIOLOGY, LLC
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
1207RC0000XCardiovascular Disease Physician9278NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DR3800OTHERRR MEDICARE PTAN
2EN355AOTHERNVMEDICARE PTAN

General Provider Information

NPI Number : 1659680635
Entity Type Code : Organization
Provider Name (Legal Business Name) : SILVER STATE CARDIOLOGY, LLC
Provider Business Mailing Address
First Line : 4200 W CHARLESTON BLVD BLDG A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1625
Country : US
Telephone Number : 702-683-7876
Fax Number : 702-331-5764
Provider Business Practice Location Address
First Line : 4200 W CHARLESTON BLVD BLDG A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1625
Country : US
Telephone Number : 702-683-7876
Fax Number : 702-331-5764
Authorized Official
Title or Position : OWNER/OFFICER
Name : JOSE AQUINO
Credential : M.D.
Telephone Number : 702-270-2721
Provider Enumeration Date : 09/24/2010
Last Update Date : 11/19/2012

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Directions to “SILVER STATE CARDIOLOGY, LLC ” Practice Location

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