Provider Demographics
NPI:1699820225
Name:CESTKOWSKI, RICHARD A (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:CESTKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5420 CORAL GABLES DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2026
Mailing Address - Country:US
Mailing Address - Phone:702-255-1516
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE
Practice Address - Street 2:SUITE D-100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0842
Practice Address - Country:US
Practice Address - Phone:702-871-2995
Practice Address - Fax:702-871-8417
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV473208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE79881Medicare UPIN