Provider Demographics
NPI:1164472528
Name:PANIAGUA, ARTHUR A (PAC)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:A
Last Name:PANIAGUA
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4540
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-4540
Mailing Address - Country:US
Mailing Address - Phone:775-882-0430
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:901 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-7460
Practice Address - Country:US
Practice Address - Phone:775-445-7630
Practice Address - Fax:775-246-7337
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA932363A00000X
CAPA16163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509025Medicaid
NV100509025Medicaid
NV293985Medicare PIN
NVV105703Medicare PIN