Provider Demographics
NPI:1043593296
Name:ENRIQUE JOSE. LACAYO, M.D., LTD.
Entity type:Organization
Organization Name:ENRIQUE JOSE. LACAYO, M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:LACAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-382-6970
Mailing Address - Street 1:2010 GOLDRING AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4002
Mailing Address - Country:US
Mailing Address - Phone:702-382-6970
Mailing Address - Fax:702-382-9493
Practice Address - Street 1:2010 GOLDRING AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4002
Practice Address - Country:US
Practice Address - Phone:702-382-6970
Practice Address - Fax:702-382-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3199207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
89707OtherHEALTH PARTNERS
NV002002214Medicaid
NV275OtherNEVADA CARE
102134004OtherRAILROAD MEDICARE
NV25647OtherBLUE CROSS
2499444OtherGHI
NVC97069Medicare UPIN