Provider Demographics
NPI:1407669898
Name:AZCUY, MARIO LUIS
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:LUIS
Last Name:AZCUY
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 1:9925 W RUSSELL RD UNIT 1100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5597
Mailing Address - Country:US
Mailing Address - Phone:702-439-6226
Mailing Address - Fax:
Practice Address - Street 1:9925 W RUSSELL RD UNIT 1100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5597
Practice Address - Country:US
Practice Address - Phone:702-439-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider