| Beduya-princer, Llc | |
|
8565 S Eastern Ave Ste 150 Las Vegas NV 89123-2906 | |
| (702) 902-0225 | |
| Not Available |
| Full Name | Beduya-princer, Llc |
|---|---|
| Speciality | General Practice |
| Location | 8565 S Eastern Ave Ste 150, Las Vegas, Nevada |
| Authorized Official Name and Position | Maria Tessie Beduya-princer (CEO) |
| Authorized Official Contact | 7029020225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beduya-princer, Llc 8565 S Eastern Ave Ste 150 Las Vegas NV 89123-2906 Ph: (702) 902-0225 | Beduya-princer, Llc 8565 S Eastern Ave Ste 150 Las Vegas NV 89123-2906 Ph: (702) 902-0225 |
| NPI Number | 1326707076 |
|---|---|
| Provider Enumeration Date | 12/09/2021 |
| Last Update Date | 12/09/2021 |
| Certification Date | 12/09/2021 |
| Medicare PECOS PAC ID | 2668863770 |
|---|---|
| Medicare Enrollment ID | O20211228002189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326707076 | NPI | - | NPPES |
| Provider Name | Ma Tessie A Beduya-princer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649249608 PECOS PAC ID: 1052373131 Enrollment ID: I20041101000635 |
| Provider Name | Consuelo Aurea Kinahan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639556855 PECOS PAC ID: 0143599464 Enrollment ID: I20170629002847 |
| Provider Name | Mario Antonio Pacada |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1114982535 PECOS PAC ID: 6901813591 Enrollment ID: I20210421001822 |
| Provider Name | Dax Wolford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851742100 PECOS PAC ID: 1759790850 Enrollment ID: I20220622001207 |
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