Provider Demographics
NPI:1194504621
Name:LUGLIO, MARIO JESUS
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:JESUS
Last Name:LUGLIO
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 1:1701 SERAFINA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4057
Mailing Address - Country:US
Mailing Address - Phone:702-672-5373
Mailing Address - Fax:
Practice Address - Street 1:2801 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1419
Practice Address - Country:US
Practice Address - Phone:702-684-7800
Practice Address - Fax:702-684-7878
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVF08230345363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care