Provider Demographics
NPI:1306807425
Name:PINEIRO, MARIO (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:PINEIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50070
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0070
Mailing Address - Country:US
Mailing Address - Phone:702-285-9368
Mailing Address - Fax:
Practice Address - Street 1:2510 WIGWAM PKWY
Practice Address - Street 2:STE # 104
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7114
Practice Address - Country:US
Practice Address - Phone:702-947-1000
Practice Address - Fax:702-947-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH99427Medicare UPIN