Provider Demographics
NPI:1902904600
Name:CABALUNA, WENCESLAO (MD)
Entity Type:Individual
Prefix:
First Name:WENCESLAO
Middle Name:
Last Name:CABALUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-4533
Mailing Address - Country:US
Mailing Address - Phone:702-796-1116
Mailing Address - Fax:702-692-4740
Practice Address - Street 1:150 E HARMON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-4533
Practice Address - Country:US
Practice Address - Phone:702-796-1116
Practice Address - Fax:702-692-4740
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7052208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B77692Medicare UPIN
39224Medicare ID - Type Unspecified