Provider Demographics
NPI:1326144577
Name:PANIAGUA, CALVIN FREDERICK II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:FREDERICK
Last Name:PANIAGUA
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 270662
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89127-4662
Mailing Address - Country:US
Mailing Address - Phone:702-823-3813
Mailing Address - Fax:725-777-3119
Practice Address - Street 1:5891 E CHARLESTON BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-1050
Practice Address - Country:US
Practice Address - Phone:725-777-3120
Practice Address - Fax:725-777-3119
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2017-04-04
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Provider Licenses
StateLicense IDTaxonomies
CA17465363A00000X
AZ3024363A00000X
NVPA1021363A00000X
CO0003911363A00000X
MI5601004343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant