Basic Information
Provider Information
NPI: 1205083847
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PANTALEON-MORALES
FirstName: ANGEL
MiddleName: JESUS
NamePrefix: MR.
NameSuffix:  
Credential: CERT SURGICAL TECH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9499 W CHARLESTON BLVD
Address2: SUITE 250
City: LAS VEGAS
State: NV
PostalCode: 891177147
CountryCode: US
TelephoneNumber: 7029333600
FaxNumber: 7029333601
Practice Location
Address1: 9499 W CHARLESTON BLVD
Address2: SUITE 250
City: LAS VEGAS
State: NV
PostalCode: 891177147
CountryCode: US
TelephoneNumber: 7029333600
FaxNumber: 7029333601
Other Information
ProviderEnumerationDate: 08/26/2008
LastUpdateDate: 08/26/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
246ZS0410X109344NVY    

No ID Information.


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