| Fuente De Vida Mental Health Services | |
|
2545 Chandler Ave Ste 7 Las Vegas NV 89120-4007 | |
| (702) 544-1638 | |
| Not Available |
| Full Name | Fuente De Vida Mental Health Services |
|---|---|
| Speciality | Social Worker |
| Location | 2545 Chandler Ave Ste 7, Las Vegas, Nevada |
| Authorized Official Name and Position | Perla Sanchez (MANAGER) |
| Authorized Official Contact | 7025726379 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fuente De Vida Mental Health Services 2545 Chandler Ave Ste 7 Las Vegas NV 89120-4007 Ph: (702) 544-1638 | Fuente De Vida Mental Health Services 2545 Chandler Ave Ste 7 Las Vegas NV 89120-4007 Ph: (702) 544-1638 |
| NPI Number | 1316538465 |
|---|---|
| Provider Enumeration Date | 02/01/2021 |
| Last Update Date | 08/12/2021 |
| Certification Date | 08/12/2021 |
| Medicare PECOS PAC ID | 4789081027 |
|---|---|
| Medicare Enrollment ID | O20210929000736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316538465 | NPI | - | NPPES |
| 250013637 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Margarita Romano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205136348 PECOS PAC ID: 2961801139 Enrollment ID: I20210520002902 |
| Provider Name | Maria Esmeralda Otame |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215359278 PECOS PAC ID: 3375941628 Enrollment ID: I20211018001376 |
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