Provider Demographics
NPI:1134373285
Name:ESTHERLOIDA P LUPERTE MD PLLC
Entity type:Organization
Organization Name:ESTHERLOIDA P LUPERTE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHERLOIDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUPERTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-464-8905
Mailing Address - Street 1:8550 W DESERT INN RD
Mailing Address - Street 2:SUITE 102-134
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4401
Mailing Address - Country:US
Mailing Address - Phone:702-921-6829
Mailing Address - Fax:702-921-6828
Practice Address - Street 1:8280 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3612
Practice Address - Country:US
Practice Address - Phone:702-921-6829
Practice Address - Fax:702-921-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1457319709Medicaid