| Amara Medical Center Llc | |
|
2619 W Charleston Blvd Ste A Las Vegas NV 89102-2121 | |
| (702) 727-9065 | |
| Not Available |
| Full Name | Amara Medical Center Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2619 W Charleston Blvd Ste A, Las Vegas, Nevada |
| Authorized Official Name and Position | Carmen Lazo (CEO) |
| Authorized Official Contact | 7027279065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amara Medical Center Llc 4616 W Sahara Ave Ste 481 Las Vegas NV 89102-3654 Ph: (702) 727-9065 | Amara Medical Center Llc 2619 W Charleston Blvd Ste A Las Vegas NV 89102-2121 Ph: (702) 727-9065 |
| NPI Number | 1881298065 |
|---|---|
| Provider Enumeration Date | 11/28/2020 |
| Last Update Date | 11/28/2020 |
| Certification Date | 11/28/2020 |
| Medicare PECOS PAC ID | 2668862194 |
|---|---|
| Medicare Enrollment ID | O20211124000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881298065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| Provider Name | Martin D Fakiel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972787000 PECOS PAC ID: 1254319544 Enrollment ID: I20040713000226 |
| Provider Name | Charles George Mahakian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881780724 PECOS PAC ID: 7315972361 Enrollment ID: I20050928001373 |
| Provider Name | Roberto Ruiz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134337652 PECOS PAC ID: 6608136874 Enrollment ID: I20180207003002 |
| Provider Name | Marjorie Vielka Landron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972919561 PECOS PAC ID: 7113267444 Enrollment ID: I20190322000793 |
| Provider Name | William Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679797633 PECOS PAC ID: 6002906096 Enrollment ID: I20200622000938 |
| Provider Name | Mohamed Omar Saleh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407800766 PECOS PAC ID: 8426054032 Enrollment ID: I20210209000672 |
| Provider Name | Hisbay H Ali |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306127311 PECOS PAC ID: 0446524565 Enrollment ID: I20210716002733 |
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