| Mark A Perez, M.d., Llc | |
|
4275 Burnham Ave Suite 235 Las Vegas NV 89119-5488 | |
| (702) 384-7669 | |
| (702) 385-7669 |
| Full Name | Mark A Perez, M.d., Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4275 Burnham Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Mark A Perez (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7023847669 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark A Perez, M.d., Llc 4275 Burnham Ave Suite 235 Las Vegas NV 89119-5488 Ph: (702) 384-7669 | Mark A Perez, M.d., Llc 4275 Burnham Ave Suite 235 Las Vegas NV 89119-5488 Ph: (702) 384-7669 |
| NPI Number | 1083962856 |
|---|---|
| Provider Enumeration Date | 08/27/2012 |
| Last Update Date | 08/27/2012 |
| Medicare PECOS PAC ID | 2365693082 |
|---|---|
| Medicare Enrollment ID | O20121106000345 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083962856 | NPI | - | NPPES |
| G00675140 | Medicaid | CA | |
| 14517 | Other | CA | NEVADA LICENSE NUMBER |
| G00675140 | Other | CA | MEDICARE ID |
| F38101 | Other | MEDICARE UPIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 14517 (Nevada) | Primary |
| Provider Name | Mark Perez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720152473 PECOS PAC ID: 3173706959 Enrollment ID: I20121106000308 |
| Provider Name | Misel Reyes Diaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841873106 PECOS PAC ID: 1557717550 Enrollment ID: I20231027000551 |
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