Provider Demographics
NPI:1114958683
Name:LACAYO, ENRIQUE J (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:J
Last Name:LACAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2010 GOLDRING AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4002
Mailing Address - Country:US
Mailing Address - Phone:702-382-6970
Mailing Address - Fax:702-382-9493
Practice Address - Street 1:2010 GOLDRING AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4002
Practice Address - Country:US
Practice Address - Phone:702-382-6970
Practice Address - Fax:702-382-9493
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV3199207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV3199OtherBLUE CROSS
NV002002214Medicaid
102134004OtherRAILROAD MEDICARE
2499444OtherGHI
89707OtherHEALTH PARTNERS
NV275OtherNEVADA CARE
NV25647OtherBLUE CROSS
89707OtherHEALTH PARTNERS