Provider Demographics
NPI:1548724727
Name:PIZARRO, WARLITO C (RFA)
Entity type:Individual
Prefix:
First Name:WARLITO
Middle Name:C
Last Name:PIZARRO
Suffix:
Gender:M
Credentials:RFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8085 MOHAWK LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-9126
Mailing Address - Country:US
Mailing Address - Phone:775-677-1105
Mailing Address - Fax:775-677-7076
Practice Address - Street 1:8115 MOHAWK LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-9126
Practice Address - Country:US
Practice Address - Phone:775-677-8115
Practice Address - Fax:775-677-7076
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3742-AGC-18310400000X
NV119-AGC-26310400000X
NVNVN118AGC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005034952Medicaid
NV9005056039Medicaid
NV9005056153Medicaid