Provider Demographics
NPI:1700965647
Name:AGAPITO B RACOMA MD LLC
Entity Type:Organization
Organization Name:AGAPITO B RACOMA MD LLC
Other - Org Name:ASSOCIATED PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGAPITO
Authorized Official - Middle Name:
Authorized Official - Last Name:RACOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-239-7905
Mailing Address - Street 1:889 S RAINBOW BLVD
Mailing Address - Street 2:#134
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508872Medicaid