Provider Demographics
NPI:1487167623
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:
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 1:1250 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-2052
Mailing Address - Country:US
Mailing Address - Phone:702-383-4001
Mailing Address - Fax:702-383-4004
Practice Address - Street 1:1250 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2052
Practice Address - Country:US
Practice Address - Phone:702-383-4001
Practice Address - Fax:702-383-4004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAMA MIA PEDIATRICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty