Provider Demographics
NPI:1386678555
Name:BERBERABE JR, EMILIO FRANCISCO A (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILIO FRANCISCO
Middle Name:A
Last Name:BERBERABE JR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1943
Mailing Address - Country:US
Mailing Address - Phone:702-877-9511
Mailing Address - Fax:702-877-9511
Practice Address - Street 1:3009 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1943
Practice Address - Country:US
Practice Address - Phone:702-877-9511
Practice Address - Fax:702-877-9511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019744Medicaid
NVVMD7868Medicare ID - Type Unspecified
NV2019744Medicaid