Provider Demographics
NPI:1043241078
Name:SIU, VIRGILIO (PAC)
Entity Type:Individual
Prefix:
First Name:VIRGILIO
Middle Name:
Last Name:SIU
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8379 W SUNSET RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2243
Mailing Address - Country:US
Mailing Address - Phone:725-200-3232
Mailing Address - Fax:725-220-6389
Practice Address - Street 1:2354 E BONANZA RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3451
Practice Address - Country:US
Practice Address - Phone:702-476-2287
Practice Address - Fax:702-718-0393
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA934363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical