Basic Information
| Provider Information | |||||||||
| NPI: | 1992993190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLO | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7065 W ANN RD STE 130-162 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891303865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024000611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 RANCHO LN STE 135 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891063826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023831958 | ||||||||
| FaxNumber: | 7023024404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2007 | ||||||||
| LastUpdateDate: | 03/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.