Provider Demographics
NPI:1780078295
Name:MASCIOTTI, NICK
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:MASCIOTTI
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 1:9047 DANESBURY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3700
Mailing Address - Country:US
Mailing Address - Phone:702-466-4804
Mailing Address - Fax:
Practice Address - Street 1:9811 W CHARLESTON BLVD
Practice Address - Street 2:BLVD 2-641
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7528
Practice Address - Country:US
Practice Address - Phone:855-864-4322
Practice Address - Fax:888-315-4512
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912171760OtherGROUP NPI