Provider Demographics
NPI:1174708325
Name:LUIS G N PANUNCIALMAN M D INC
Entity type:Organization
Organization Name:LUIS G N PANUNCIALMAN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:GREGORIO
Authorized Official - Last Name:PANUNCIALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-474-2460
Mailing Address - Street 1:2911 N TENAYA WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0464
Mailing Address - Country:US
Mailing Address - Phone:702-474-7246
Mailing Address - Fax:702-474-7529
Practice Address - Street 1:2911 N TENAYA WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0464
Practice Address - Country:US
Practice Address - Phone:702-474-2460
Practice Address - Fax:702-474-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty