Provider Demographics
NPI:1821195413
Name:ASIMENIOS, VALERIA (MD)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:ASIMENIOS
Suffix:
Gender:F
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:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-877-5199
Mailing Address - Fax:702-984-5194
Practice Address - Street 1:4835 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8171
Practice Address - Country:US
Practice Address - Phone:702-877-5199
Practice Address - Fax:702-984-5194
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203856207R00000X
NV13063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBV309ZOtherMEDICARE REVALIDATION
NV1821195413Medicaid
NVBV309YMedicare PIN
NV18N672Medicare PIN
NV1821195413Medicaid
NYG41886Medicare UPIN