MEDICARE: DR. DON PEPITO, 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
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	16969	NV

General Provider Information

NPI Number	:	1740766005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. DON PEPITO, LLC

Provider Business Mailing Address
First Line	:	9315 W SUNSET RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5012
Country	:	US
Telephone Number	:	702-638-7705
Fax Number	:	702-638-7706

Provider Business Practice Location Address
First Line	:	9315 W SUNSET RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5012
Country	:	US
Telephone Number	:	702-638-7705
Fax Number	:	702-638-7706

Authorized Official
Title or Position	:	OWNER
Name	:	DON PEPITO
Credential	:	MD
Telephone Number	:	702-638-7705

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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