Provider Demographics
NPI:1083611362
Name:FAYLONA, EDGARDO AVERION (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:AVERION
Last Name:FAYLONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7319
Mailing Address - Country:US
Mailing Address - Phone:702-822-2000
Mailing Address - Fax:702-938-2237
Practice Address - Street 1:2300 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2149
Practice Address - Country:US
Practice Address - Phone:702-724-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6872207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV830003909OtherRAILROAD MEDICARE
NV002019348Medicaid
AZ453457Medicaid
AZ453457Medicaid
NV830003909OtherRAILROAD MEDICARE