Individual
RICARDO MOGOLLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7061 GRAND MONTECITO PKWY, LAS VEGAS, NV 89149-0287
(702) 750-3900
(702) 750-3853
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 877-5153
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10775
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100503392
—
NV
05
—
1114993425
—
NV
01
—
P00989966
RAILROAD MEDICARE
NV
Enumeration date
02/27/2006
Last updated
06/18/2024
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