| Clinica Santa Maria Llc | |
|
2354 E Bonanza Rd Las Vegas NV 89101-3451 | |
| (702) 399-9161 | |
| Not Available |
| Full Name | Clinica Santa Maria Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2354 E Bonanza Rd, Las Vegas, Nevada |
| Authorized Official Name and Position | Robert Joseph Webb (MANAGING PARTNER) |
| Authorized Official Contact | 7023999161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Santa Maria Llc Po Box 36340 Las Vegas NV 89133-6340 Ph: (702) 735-1960 | Clinica Santa Maria Llc 2354 E Bonanza Rd Las Vegas NV 89101-3451 Ph: (702) 399-9161 |
| NPI Number | 1972697712 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 07/06/2011 |
| Medicare PECOS PAC ID | 9638191794 |
|---|---|
| Medicare Enrollment ID | O20060103000806 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972697712 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 14003243100349 (Nevada) | Primary |
| Provider Name | Tri M Truong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821033879 PECOS PAC ID: 8224038468 Enrollment ID: I20070111000331 |
| Provider Name | Judith D Larkin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306063193 PECOS PAC ID: 3779615448 Enrollment ID: I20100715000287 |
| Provider Name | Jay Jay M Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336429745 PECOS PAC ID: 1456504307 Enrollment ID: I20121231000346 |
| Provider Name | Cesar S Estillore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649517970 PECOS PAC ID: 9739252180 Enrollment ID: I20130530000507 |
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