Provider Demographics
NPI:1659414654
Name:MARIO F. TARQUINO M.D. INC.
Entity Type:Organization
Organization Name:MARIO F. TARQUINO M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:TARQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-454-8236
Mailing Address - Street 1:3230 E FLAMINGO RD # 334
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4320
Mailing Address - Country:US
Mailing Address - Phone:702-454-8236
Mailing Address - Fax:702-454-8279
Practice Address - Street 1:3230 E FLAMINGO RD # 334
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4320
Practice Address - Country:US
Practice Address - Phone:702-454-8236
Practice Address - Fax:702-454-8279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG38643Medicare UPIN
NV101689Medicare ID - Type Unspecified