MEDICARE: ANSLEM A OPARAUGO 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	10268	NV
2	2080P0208X	Pediatric Infectious Diseases Physician	10268	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699785147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANSLEM A OPARAUGO MD

Provider Business Mailing Address
First Line	:	3050 E BONANZA RD
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3703
Country	:	US
Telephone Number	:	702-383-0663
Fax Number	:	702-383-0163

Provider Business Practice Location Address
First Line	:	3050 E BONANZA RD
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3703
Country	:	US
Telephone Number	:	702-383-0663
Fax Number	:	702-383-0163

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	08/01/2012

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