Provider Demographics
NPI:1225215056
Name:L.F. MORTILLARO, PH.D., LTD
Entity Type:Organization
Organization Name:L.F. MORTILLARO, PH.D., LTD
Other - Org Name:LOUIS F. MORTILLARO, PH.D & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MORTILLARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-388-9403
Mailing Address - Street 1:501 S RANCHO DR
Mailing Address - Street 2:SUITE F-37
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4828
Mailing Address - Country:US
Mailing Address - Phone:702-388-9403
Mailing Address - Fax:
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:SUITE F-37
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-388-9403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY169103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36065Medicare PIN
NV2602011Medicare UPIN