MEDICARE: BRIAN CITRO MD PC

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	208600000X	Surgery Physician	11968	NV

General Provider Information

NPI Number	:	1780790741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN CITRO MD PC

Provider Business Mailing Address
First Line	:	PO BOX 50204
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89016-0204
Country	:	US
Telephone Number	:	702-648-9400
Fax Number	:	702-636-0249

Provider Business Practice Location Address
First Line	:	3150 N TENAYA WAY
Second Line	:	SUITE 550
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0443
Country	:	US
Telephone Number	:	702-648-9400
Fax Number	:	702-636-0249

Authorized Official
Title or Position	:	CONSULTANT
Name	:	DIANA LEE
Credential	:
Telephone Number	:	702-798-3008

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/04/2014

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