MEDICARE: MR. NICHOLAS JOSEPH PUGLIA I

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	225400000X	Rehabilitation Practitioner	2101526688	NV

General Provider Information

NPI Number	:	1952677759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS JOSEPH PUGLIA I

Provider Business Mailing Address
First Line	:	3213 PARAGON POINTE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6703
Country	:	US
Telephone Number	:	702-994-7076
Fax Number	:

Provider Business Practice Location Address
First Line	:	2349 RENAISSANCE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6191
Country	:	US
Telephone Number	:	702-739-7716
Fax Number	:

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

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	03/26/2012

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