| Rd Prabhu-lata K Shete Mds Ltd | |
|
5701 W Charleston Blvd Suite 100 Las Vegas NV 89146-1217 | |
| (702) 877-9514 | |
| (702) 877-0399 |
| Full Name | Rd Prabhu-lata K Shete Mds Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 5701 W Charleston Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Rachakonda Dayananda Prabhu (PRESIDENT) |
| Authorized Official Contact | 7028779514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rd Prabhu-lata K Shete Mds Ltd 5701 W Charleston Blvd Suite 100 Las Vegas NV 89146-1217 Ph: (702) 877-9514 | Rd Prabhu-lata K Shete Mds Ltd 5701 W Charleston Blvd Suite 100 Las Vegas NV 89146-1217 Ph: (702) 877-9514 |
| NPI Number | 1912995309 |
|---|---|
| Provider Enumeration Date | 10/10/2005 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8820994791 |
|---|---|
| Medicare Enrollment ID | O20031210001032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912995309 | NPI | - | NPPES |
| 100506357 | Medicaid | NV | |
| XGG00737 | Other | CA | MEDI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Sunil K Darbari |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1932197290 PECOS PAC ID: 3678475308 Enrollment ID: I20040123000178 |
| Provider Name | Chakravarthy R Kannan |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1659342236 PECOS PAC ID: 5799678272 Enrollment ID: I20040206000890 |
| Provider Name | Rachakonda D Prabhu |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1538156633 PECOS PAC ID: 8729996590 Enrollment ID: I20040519000848 |
| Provider Name | Ammar Wehbeh |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669461455 PECOS PAC ID: 7517914872 Enrollment ID: I20050407001217 |
| Provider Name | Lata K Shete |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1326036005 PECOS PAC ID: 7810805686 Enrollment ID: I20051114000309 |
| Provider Name | Robert Reyna |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1477620284 PECOS PAC ID: 5698836450 Enrollment ID: I20090423000707 |
| Provider Name | Jennifer D Avena |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578528998 PECOS PAC ID: 8426181439 Enrollment ID: I20100728000215 |
| Provider Name | Margaret A Riedl |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1104158674 PECOS PAC ID: 0547454332 Enrollment ID: I20120518000483 |
| Provider Name | Tara Dayananda Rachakonda |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1508093345 PECOS PAC ID: 2365683505 Enrollment ID: I20181017002338 |
| Provider Name | Rosemarie Salacup Lizardo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083251250 PECOS PAC ID: 6608207618 Enrollment ID: I20200507000545 |
| Provider Name | Irishanne Venditto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437787728 PECOS PAC ID: 1456776749 Enrollment ID: I20200804000567 |
| Provider Name | Jessica Mae Lorenzana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629648928 PECOS PAC ID: 7113321183 Enrollment ID: I20210812002759 |
| Provider Name | Sibimol Sabu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497417539 PECOS PAC ID: 8426447681 Enrollment ID: I20211110001356 |
| Provider Name | Dulip Ratnasoma |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1609293638 PECOS PAC ID: 7315143328 Enrollment ID: I20220505002389 |
| Provider Name | Noelys De Armas Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528707734 PECOS PAC ID: 5092173070 Enrollment ID: I20230623000421 |
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