Provider Demographics
NPI:1679546493
Name:FACINOLI, JOHN F (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:FACINOLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 MARBRISAS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-5151
Mailing Address - Country:US
Mailing Address - Phone:702-655-9022
Mailing Address - Fax:
Practice Address - Street 1:5905 MARBRISAS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-5151
Practice Address - Country:US
Practice Address - Phone:702-655-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV422207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV101703Medicare ID - Type UnspecifiedMEDICARE PART B
NVC35189Medicare UPIN