Provider Demographics
NPI:1386033231
Name:REOLEGIO, MICHAEL (TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:REOLEGIO
Suffix:
Gender:M
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8084 W. SAHARA AVE.
Mailing Address - Street 2:STE B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-257-7246
Mailing Address - Fax:702-586-2071
Practice Address - Street 1:8084 W. SAHARA AVE.
Practice Address - Street 2:STE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-257-7246
Practice Address - Fax:702-586-2071
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other