Provider Demographics
NPI:1518049154
Name:BIAZZO, SALVATORE J (DO)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:J
Last Name:BIAZZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4020
Mailing Address - Country:US
Mailing Address - Phone:702-366-1206
Mailing Address - Fax:702-366-0993
Practice Address - Street 1:517 ROSE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4020
Practice Address - Country:US
Practice Address - Phone:702-366-1206
Practice Address - Fax:702-366-0993
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG42335Medicare UPIN