Individual
MARIO J. GASPAR DE ALBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
630 S RANCHO DR STE A, LAS VEGAS, NV 89106-4849
(702) 998-9505
(702) 527-7939
Mailing address
3016 W CHARLESTON BLVD STE 100, LAS VEGAS, NV 89102-1973
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
14554
NV
2080P0006X
Developmental - Behavioral Pediatrics Physician
M3232
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275546590
—
NV
05
—
178999201
—
TX
01
—
8H0437
BC/BS OF TEXAS
TX
01
—
GW226Z
MEDICARE
NV
Enumeration date
08/15/2006
Last updated
06/02/2020
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