Provider Demographics
NPI:1871675959
Name:CARPO, GABRIEL P (MD)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:P
Last Name:CARPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 E CHEYENNE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-8442
Mailing Address - Country:US
Mailing Address - Phone:702-633-4000
Mailing Address - Fax:702-633-4346
Practice Address - Street 1:2315 E CHEYENNE AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-8442
Practice Address - Country:US
Practice Address - Phone:702-633-4000
Practice Address - Fax:702-633-4346
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018676Medicaid
NV34199Medicare ID - Type Unspecified
NV002018676Medicaid