Provider Demographics
NPI:1831666148
Name:CONCEPCION, RAMON ALEX (RD, LD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:ALEX
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 CAMBRIDGE CREST CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-6201
Mailing Address - Country:US
Mailing Address - Phone:702-217-5220
Mailing Address - Fax:
Practice Address - Street 1:7385 S PECOS RD STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3768
Practice Address - Country:US
Practice Address - Phone:702-463-3300
Practice Address - Fax:702-441-0251
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39012-DI-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered