Provider Demographics
NPI:1891096343
Name:MAMA MIA PEDIATRICS LLC
Entity Type:Organization
Organization Name:MAMA MIA PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-596-2293
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1871675959OtherNPI
NV1871675959OtherNPI