Provider Demographics
NPI:1578602579
Name:PICENO, JESSIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:M
Last Name:PICENO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2820 W CHARLESTON BLVD STE 33
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1934
Mailing Address - Country:US
Mailing Address - Phone:702-880-1558
Mailing Address - Fax:702-870-6821
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 33
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1934
Practice Address - Country:US
Practice Address - Phone:702-880-1558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV14024207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ630186Medicaid
NV1578602579Medicaid
NV14024OtherNV MEDICAL LICENSE