| Bauza Neuropsychiatry Center Llc | |
|
4268 Roanridge Ave Las Vegas NV 89120-2113 | |
| (702) 810-0066 | |
| Not Available |
| Full Name | Bauza Neuropsychiatry Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4268 Roanridge Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Luis Angel Rodriguez Bauza (OWNER) |
| Authorized Official Contact | 7028100066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bauza Neuropsychiatry Center Llc 4268 Roanridge Ave Las Vegas NV 89120-2113 Ph: (702) 810-0066 | Bauza Neuropsychiatry Center Llc 4268 Roanridge Ave Las Vegas NV 89120-2113 Ph: (702) 810-0066 |
| NPI Number | 1912596685 |
|---|---|
| Provider Enumeration Date | 01/15/2021 |
| Last Update Date | 01/15/2021 |
| Certification Date | 01/15/2021 |
| Medicare PECOS PAC ID | 7618370040 |
|---|---|
| Medicare Enrollment ID | O20210722003696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912596685 | NPI | - | NPPES |
| 1700277464 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Maria G Gregory |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1639148596 PECOS PAC ID: 6709840440 Enrollment ID: I20041112000993 |
| Provider Name | Jacinta F Cruz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588908628 PECOS PAC ID: 6406091073 Enrollment ID: I20130402000398 |
| Provider Name | Sam Zand |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528485570 PECOS PAC ID: 1557581352 Enrollment ID: I20170822003558 |
| Provider Name | Nicole B Anders |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053771105 PECOS PAC ID: 7517212020 Enrollment ID: I20180622002316 |
| Provider Name | Zinoviy Benzar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598853343 PECOS PAC ID: 6002089539 Enrollment ID: I20190530000167 |
| Provider Name | Michael Popov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518351097 PECOS PAC ID: 0244546505 Enrollment ID: I20190626003953 |
| Provider Name | Sandra Owens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881024909 PECOS PAC ID: 5991125304 Enrollment ID: I20201022002832 |
| Provider Name | Carlos Enrique Jimenez Pozo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215579602 PECOS PAC ID: 7416388996 Enrollment ID: I20210223001871 |
| Provider Name | Mario Jose Valdes Espino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194497735 PECOS PAC ID: 4183017767 Enrollment ID: I20220202002192 |
| Provider Name | Grant Bullock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174086391 PECOS PAC ID: 9032444120 Enrollment ID: I20230717001897 |
| Provider Name | Gerardo Wence-munoz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174895874 PECOS PAC ID: 1052764636 Enrollment ID: I20240131000378 |
| Provider Name | Gordana Brabson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1952507832 PECOS PAC ID: 5092159830 Enrollment ID: I20240220001787 |
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