Provider Demographics
NPI:1124906805
Name:PANGILINAN, ROBERTO MORENO
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:MORENO
Last Name:PANGILINAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1835
Mailing Address - Country:US
Mailing Address - Phone:702-505-8225
Mailing Address - Fax:702-760-0965
Practice Address - Street 1:3301 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1835
Practice Address - Country:US
Practice Address - Phone:702-505-8225
Practice Address - Fax:702-760-0965
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN27648163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator