Provider Demographics
NPI:1639172448
Name:BELIZARIO, MARCELINO CUCIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELINO
Middle Name:CUCIO
Last Name:BELIZARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2466
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1000 S RAINBOW BLVD
Practice Address - Street 2:STE. A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6231
Practice Address - Country:US
Practice Address - Phone:702-464-8866
Practice Address - Fax:702-671-6851
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1639172448Medicaid
NVBI528Y (CQ328A)Medicare PIN
NVV100666Medicare PIN
NV1639172448Medicaid
G62563Medicare UPIN