Provider Demographics
NPI:1083809065
Name:FOJTIK, MARIO (CERTIFIED SCRUB TECH)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:FOJTIK
Suffix:
Gender:M
Credentials:CERTIFIED SCRUB TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 SMOKE RANCH RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8393
Mailing Address - Country:US
Mailing Address - Phone:702-320-8111
Mailing Address - Fax:702-320-8112
Practice Address - Street 1:7140 SMOKE RANCH RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8393
Practice Address - Country:US
Practice Address - Phone:702-320-8111
Practice Address - Fax:702-320-8112
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other