Individual
MR. CARLO MARIO VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
888 S RANCHO DR, LAS VEGAS, NV 89106-3810
(702) 877-8600
(702) 258-6152
Mailing address
PO BOX 15645, LAS VEGAS, NV 89114-5645
(702) 877-8600
(702) 258-6152
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
588
NV
363A00000X
Physician Assistant
633
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194812438
SMA MEDICAID
NV
01
—
V111167
SMA MEDICARE
NV
Enumeration date
10/06/2006
Last updated
01/23/2017
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