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2755 E Desert Inn Rd Ste 180 Las Vegas NV 89121-3694 | |
| (702) 826-8889 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 2755 E Desert Inn Rd Ste 180, Las Vegas, Nevada |
| Authorized Official Name and Position | Claudia Avila (COO) |
| Authorized Official Contact | 7028268889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2755 E Desert Inn Rd Ste 180 Las Vegas NV 89121-3694 Ph: (702) 826-8889 | 2755 E Desert Inn Rd Ste 180 Las Vegas NV 89121-3694 Ph: (702) 826-8889 |
| NPI Number | 1528628633 |
|---|---|
| Provider Enumeration Date | 06/20/2019 |
| Last Update Date | 04/22/2022 |
| Certification Date | 04/22/2022 |
| Medicare PECOS PAC ID | 9638405624 |
|---|---|
| Medicare Enrollment ID | O20190729003618 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528628633 | NPI | - | NPPES |
| 250002866 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Jacqueline J Leventhal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245494731 PECOS PAC ID: 2163417445 Enrollment ID: I20040416000517 |
| Provider Name | Robert H Odell |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1013957026 PECOS PAC ID: 8022902626 Enrollment ID: I20040622001472 |
| Provider Name | Orlandis L Wells |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1356399620 PECOS PAC ID: 4486676376 Enrollment ID: I20051220000355 |
| Provider Name | Chris A Doss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861682494 PECOS PAC ID: 6800997248 Enrollment ID: I20080410000042 |
| Provider Name | Emma B Cempron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073709192 PECOS PAC ID: 9234322108 Enrollment ID: I20101023000190 |
| Provider Name | Ayele E Amavigan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497921605 PECOS PAC ID: 2062725369 Enrollment ID: I20150715001997 |
| Provider Name | Krayton E Stephens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013186030 PECOS PAC ID: 0749433811 Enrollment ID: I20160404000438 |
| Provider Name | Marjorie Vielka Landron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972919561 PECOS PAC ID: 7113267444 Enrollment ID: I20190322000793 |
| Provider Name | Zinoviy Benzar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598853343 PECOS PAC ID: 6002089539 Enrollment ID: I20190530000167 |
| Provider Name | Deja Fuimaono |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497028682 PECOS PAC ID: 4385079748 Enrollment ID: I20200114001333 |
| Provider Name | Nadiasly M Santillano Cuesta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134595259 PECOS PAC ID: 9032521083 Enrollment ID: I20201215002728 |
| Provider Name | Estrella P Evangelista |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114445756 PECOS PAC ID: 9739560855 Enrollment ID: I20220721000872 |
| Provider Name | Shane Michael Boxrz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043930894 PECOS PAC ID: 0547639528 Enrollment ID: I20221214000718 |
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