Basic Information
Provider Information
NPI: 1376803171
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CONCIO
FirstName: CONRADO
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1800 W. CHARLESTON BLVD. STE. 508
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 89102
CountryCode: US
TelephoneNumber: 7023832688
FaxNumber: 7026716595
Practice Location
Address1: 4760 BLUE DIAMOND RD. STE. 110
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 89137
CountryCode: US
TelephoneNumber: 7023832300
FaxNumber: 7026781886
Other Information
ProviderEnumerationDate: 05/25/2012
LastUpdateDate: 08/30/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X16344NVY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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