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9653 Mesa Ridge Ct Las Vegas NV 89129 | |
| (702) 232-4210 | |
| (702) 453-7005 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 9653 Mesa Ridge Ct, Las Vegas, Nevada |
| Authorized Official Name and Position | John P Valles (PRESIDENT) |
| Authorized Official Contact | 7027970588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
9653 Mesa Ridge Ct Las Vegas NV 89129 Ph: (702) 232-4210 | 9653 Mesa Ridge Ct Las Vegas NV 89129 Ph: (702) 232-4210 |
| NPI Number | 1538226931 |
|---|---|
| Provider Enumeration Date | 01/03/2007 |
| Last Update Date | 03/09/2015 |
| Medicare PECOS PAC ID | 2769572072 |
|---|---|
| Medicare Enrollment ID | O20071226000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538226931 | NPI | - | NPPES |
| V104918 | Other | NV | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 10710 (Nevada) | Primary |
| Provider Name | John P Valles |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972545994 PECOS PAC ID: 8820060163 Enrollment ID: I20040809000354 |
| Provider Name | Michelle Keiserman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083841217 PECOS PAC ID: 8426274531 Enrollment ID: I20140725002265 |
| Provider Name | Jenny Lm Casino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194148759 PECOS PAC ID: 4688064827 Enrollment ID: I20211202001982 |
| Provider Name | Kurt Ricardo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336719764 PECOS PAC ID: 6608267307 Enrollment ID: I20220106000188 |
| Provider Name | Maria Mondonedo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356052765 PECOS PAC ID: 8628423738 Enrollment ID: I20231010001937 |
| Provider Name | Mark Z Quim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780456350 PECOS PAC ID: 2860844461 Enrollment ID: I20240119000170 |
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