MEDICARE: ASPACIO DERMATOLOGY A PROFESSIONAL CORPORATION

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	207N00000X	Dermatology Physician	7900	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

General Provider Information

NPI Number	:	1750613105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPACIO DERMATOLOGY A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	8310 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1873
Country	:	US
Telephone Number	:	702-243-4501
Fax Number	:	702-947-6077

Provider Business Practice Location Address
First Line	:	8310 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1873
Country	:	US
Telephone Number	:	702-243-4501
Fax Number	:	702-243-4701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. REUEL M ASPACIO
Credential	:	MD
Telephone Number	:	702-243-4501

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	03/11/2014

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