| Hcpn At City Impact Wellness Clinic Llc | |
|
968 E Sahara Ave Ste C Las Vegas NV 89104-3022 | |
| (702) 871-9917 | |
| Not Available |
| Full Name | Hcpn At City Impact Wellness Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 968 E Sahara Ave Ste C, Las Vegas, Nevada |
| Authorized Official Name and Position | Jose Viray (OWNER) |
| Authorized Official Contact | 7028719917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hcpn At City Impact Wellness Clinic Llc 4850 W Flamingo Rd Ste 25 Las Vegas NV 89103-3707 Ph: (702) 871-9917 | Hcpn At City Impact Wellness Clinic Llc 968 E Sahara Ave Ste C Las Vegas NV 89104-3022 Ph: (702) 871-9917 |
| NPI Number | 1023576840 |
|---|---|
| Provider Enumeration Date | 03/11/2019 |
| Last Update Date | 03/11/2019 |
| Medicare PECOS PAC ID | 1052642501 |
|---|---|
| Medicare Enrollment ID | O20191014003043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023576840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Dorothy May Agdamag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780195446 PECOS PAC ID: 0840558524 Enrollment ID: I20180102000167 |
| Provider Name | Genevie Kneir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760922017 PECOS PAC ID: 1951660810 Enrollment ID: I20180123000009 |
| Provider Name | Natalia B Videva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962906586 PECOS PAC ID: 2567717895 Enrollment ID: I20180608002236 |
| Provider Name | Gemma Viray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083295406 PECOS PAC ID: 1759388788 Enrollment ID: I20210709002500 |
| Provider Name | Alexandra N Viray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588248330 PECOS PAC ID: 9133518004 Enrollment ID: I20211115001916 |
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