Provider Demographics
NPI:1114056462
Name:ROBERTO C CHUAPOCO MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROBERTO C CHUAPOCO MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:DE CASTRO
Authorized Official - Last Name:CHUAPOCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-501-3500
Mailing Address - Street 1:8608 MIRADA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8206
Mailing Address - Country:US
Mailing Address - Phone:702-988-7028
Mailing Address - Fax:702-988-7028
Practice Address - Street 1:908 S VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4412
Practice Address - Country:US
Practice Address - Phone:702-501-3500
Practice Address - Fax:702-988-7028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11482208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH74901Medicare UPIN