| Ejaz Kamboj, Md, Inc. | |
|
1770 N Buffalo Dr Ste 103 Las Vegas NV 89128-2679 | |
| (702) 650-0009 | |
| (702) 233-5764 |
| Full Name | Ejaz Kamboj, Md, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1770 N Buffalo Dr Ste 103, Las Vegas, Nevada |
| Authorized Official Name and Position | Ejaz U Kamboj (OWNER) |
| Authorized Official Contact | 7026500009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ejaz Kamboj, Md, Inc. 1770 N Buffalo Dr Ste 103 Las Vegas NV 89128-2679 Ph: (702) 650-0009 | Ejaz Kamboj, Md, Inc. 1770 N Buffalo Dr Ste 103 Las Vegas NV 89128-2679 Ph: (702) 650-0009 |
| NPI Number | 1225254139 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 10/08/2018 |
| Medicare PECOS PAC ID | 3173417516 |
|---|---|
| Medicare Enrollment ID | O20040209000504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225254139 | NPI | - | NPPES |
| 2018267 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | (* (Not Available)) | Primary |
| Provider Name | Ejaz U Kamboj |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1396833810 PECOS PAC ID: 5092616391 Enrollment ID: I20040120000113 |
| Provider Name | Lisa Ann Moreno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194262519 PECOS PAC ID: 2668758533 Enrollment ID: I20170406002337 |
| Provider Name | Anthony R Denina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427551936 PECOS PAC ID: 5698017556 Enrollment ID: I20190425002219 |
| Provider Name | May B Denina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902309230 PECOS PAC ID: 0749283133 Enrollment ID: I20201001003196 |
| Provider Name | Janice M Flores |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063034049 PECOS PAC ID: 2769895291 Enrollment ID: I20201230001215 |
| Provider Name | Amor Antonio M Flores |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013539170 PECOS PAC ID: 6800209172 Enrollment ID: I20210105001434 |
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