| Ark Medical Of Las Vegas Llc | |
|
2820 W Charleston Blvd Ste D40 Las Vegas NV 89102-1942 | |
| (725) 205-0288 | |
| (725) 204-9792 |
| Full Name | Ark Medical Of Las Vegas Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2820 W Charleston Blvd Ste D40, Las Vegas, Nevada |
| Authorized Official Name and Position | Cecilio P Gonzales (PRESIDENT/OWNER) |
| Authorized Official Contact | 6192597118 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ark Medical Of Las Vegas Llc 7521 Slipper Orchid St Las Vegas NV 89148-2616 Ph: (619) 259-7118 | Ark Medical Of Las Vegas Llc 2820 W Charleston Blvd Ste D40 Las Vegas NV 89102-1942 Ph: (725) 205-0288 |
| NPI Number | 1073394748 |
|---|---|
| Provider Enumeration Date | 10/10/2023 |
| Last Update Date | 01/14/2024 |
| Certification Date | 01/14/2024 |
| Medicare PECOS PAC ID | 6800247768 |
|---|---|
| Medicare Enrollment ID | O20240105000114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073394748 | NPI | - | NPPES |
| Provider Name | Cecilio P Gonzales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871947291 PECOS PAC ID: 4082993696 Enrollment ID: I20210916002025 |
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