| Av Resuello Medical Group | |
|
1300 S Maryland Pkwy Las Vegas NV 89104-3310 | |
| (702) 385-4929 | |
| (702) 385-4457 |
| Full Name | Av Resuello Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1300 S Maryland Pkwy, Las Vegas, Nevada |
| Authorized Official Name and Position | Adelaida Valerio Resuello (PRESIDENT) |
| Authorized Official Contact | 7023854929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Av Resuello Medical Group 1300 S Maryland Pkwy Las Vegas NV 89104-3310 Ph: (702) 385-4929 | Av Resuello Medical Group 1300 S Maryland Pkwy Las Vegas NV 89104-3310 Ph: (702) 385-4929 |
| NPI Number | 1184964306 |
|---|---|
| Provider Enumeration Date | 02/25/2013 |
| Last Update Date | 02/25/2013 |
| Medicare PECOS PAC ID | 9032364971 |
|---|---|
| Medicare Enrollment ID | O20130227000097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184964306 | NPI | - | NPPES |
| 002019195 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 8004 (Nevada) | Primary |
| 208000000X | Pediatrics | 8004 (Nevada) | Secondary |
| Provider Name | Adelaida Valerio Resuello |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194786582 PECOS PAC ID: 0143255356 Enrollment ID: I20050927000767 |
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