Provider Demographics
NPI:1699785147
Name:OPARAUGO, ANSLEM A (MD)
Entity type:Individual
Prefix:
First Name:ANSLEM
Middle Name:A
Last Name:OPARAUGO
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 1:3050 E BONANZA RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3703
Mailing Address - Country:US
Mailing Address - Phone:702-383-0663
Mailing Address - Fax:702-383-0163
Practice Address - Street 1:3050 E BONANZA RD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3703
Practice Address - Country:US
Practice Address - Phone:702-383-0663
Practice Address - Fax:702-383-0163
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10268208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018811Medicaid
NV1386962322Medicaid
NV1386962322Medicaid