Provider Demographics
NPI:1952326282
Name:RACOMA, AGAPITO (MD)
Entity Type:Individual
Prefix:
First Name:AGAPITO
Middle Name:
Last Name:RACOMA
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 1:889 S RAINBOW BLVD # 134
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:775-751-0405
Practice Address - Street 1:7000 SPRING MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3816
Practice Address - Country:US
Practice Address - Phone:702-239-7905
Practice Address - Fax:775-751-0405
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019328Medicaid
NV002019328Medicaid
NVF46940Medicare UPIN