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NPI Code Detail

MEDICARE: AGAPITO B RACOMA MD LLC

MEDICARE: AGAPITO B RACOMA MD 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
12084P0800XPsychiatry Physician6553NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700965647
Entity Type Code : Organization
Provider Name (Legal Business Name) : AGAPITO B RACOMA MD LLC
Provider Business Mailing Address
First Line : 889 S RAINBOW BLVD
Second Line : #134
City : LAS VEGAS
State : NV
Zip : 89145-6238
Country : US
Telephone Number :
Fax Number : 775-751-0405
Provider Business Practice Location Address
First Line : 7000 SPRING MOUNTAIN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-3816
Country : US
Telephone Number : 702-239-7905
Fax Number : 775-751-0405
Authorized Official
Title or Position : PRESIDENT OWNER
Name : AGAPITO RACOMA
Credential : MD
Telephone Number : 702-239-7905
Provider Enumeration Date : 11/02/2006
Last Update Date : 08/30/2016

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