Provider Demographics
NPI:1366420887
Name:ASPACIO, REUEL A (MD)
Entity type:Individual
Prefix:DR
First Name:REUEL
Middle Name:A
Last Name:ASPACIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:REUEL
Other - Middle Name:M
Other - Last Name:ASPACIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8310 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1873
Mailing Address - Country:US
Mailing Address - Phone:702-243-4501
Mailing Address - Fax:702-243-4701
Practice Address - Street 1:8310 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1873
Practice Address - Country:US
Practice Address - Phone:702-243-4501
Practice Address - Fax:702-243-4701
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019666Medicaid
NVV35038Medicare UPIN
CW092Medicare UPIN