| Luis Carlos O Ortega | |
|
620 S Tonopah Dr Las Vegas NV 89106-4029 | |
| (702) 413-1391 | |
| (702) 413-1392 |
| Full Name | Luis Carlos O Ortega |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 620 S Tonopah Dr, Las Vegas, Nevada |
| Authorized Official Name and Position | Luisa Carla Ortega (SECRETARY) |
| Authorized Official Contact | 7026290131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Luis Carlos O Ortega 620 S Tonopah Dr Las Vegas NV 89106-4029 Ph: (702) 413-1391 | Luis Carlos O Ortega 620 S Tonopah Dr Las Vegas NV 89106-4029 Ph: (702) 413-1391 |
| NPI Number | 1760195796 |
|---|---|
| Provider Enumeration Date | 01/04/2023 |
| Last Update Date | 06/21/2023 |
| Certification Date | 06/21/2023 |
| Medicare PECOS PAC ID | 2062886617 |
|---|---|
| Medicare Enrollment ID | O20230707002947 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760195796 | NPI | - | NPPES |
| 002019513 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Luis Carlos O Ortega |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831296904 PECOS PAC ID: 8123000874 Enrollment ID: I20040604000994 |
| Provider Name | Valerie C Siazon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881240216 PECOS PAC ID: 3375977473 Enrollment ID: I20191226000442 |
| Provider Name | Kevin Roa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609597392 PECOS PAC ID: 5991174179 Enrollment ID: I20221209001603 |
| Provider Name | Amanda Westlund |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184096505 PECOS PAC ID: 6103268206 Enrollment ID: I20240521002299 |
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