Provider Demographics
NPI:1851701676
Name:ARCEGA, PERCIVAL M
Entity Type:Individual
Prefix:MR
First Name:PERCIVAL
Middle Name:M
Last Name:ARCEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5447 S DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1849
Mailing Address - Country:US
Mailing Address - Phone:702-222-0034
Mailing Address - Fax:702-222-0659
Practice Address - Street 1:5447 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1849
Practice Address - Country:US
Practice Address - Phone:702-222-0034
Practice Address - Fax:702-222-0659
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV225400000XOtherREHABILATION PRACTIONER