| Firebird Llc | |
|
601 S 10th St Las Vegas NV 89101-7027 | |
| (702) 401-3632 | |
| (702) 382-4071 |
| Full Name | Firebird Llc |
|---|---|
| Speciality | Social Worker |
| Location | 601 S 10th St, Las Vegas, Nevada |
| Authorized Official Name and Position | Phung Horton Jefferson (MANAGING MEMBER) |
| Authorized Official Contact | 7024013632 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Firebird Llc Po Box 12924 Las Vegas NV 89112-0924 Ph: (702) 401-3632 | Firebird Llc 601 S 10th St Las Vegas NV 89101-7027 Ph: (702) 401-3632 |
| NPI Number | 1912281486 |
|---|---|
| Provider Enumeration Date | 10/03/2011 |
| Last Update Date | 04/20/2016 |
| Medicare PECOS PAC ID | 5092023069 |
|---|---|
| Medicare Enrollment ID | O20150925000084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912281486 | NPI | - | NPPES |
| Provider Name | Alan B Jauregui |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972792075 PECOS PAC ID: 4082870001 Enrollment ID: I20120720000469 |
| Provider Name | Victor S Ingram |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043745557 PECOS PAC ID: 1557795697 Enrollment ID: I20191226002130 |
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