| Southern Nevada Medical & Pediatrics Associates Llc | |
|
3301 W Charleston Blvd Las Vegas NV 89102-1835 | |
| (702) 968-0100 | |
| (702) 968-0104 |
| Full Name | Southern Nevada Medical & Pediatrics Associates Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3301 W Charleston Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Camilo Tabora (MANAGING PARTNER) |
| Authorized Official Contact | 7029680100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Nevada Medical & Pediatrics Associates Llc 3301 W Charleston Blvd Las Vegas NV 89102-1835 Ph: (702) 968-0100 | Southern Nevada Medical & Pediatrics Associates Llc 3301 W Charleston Blvd Las Vegas NV 89102-1835 Ph: (702) 968-0100 |
| NPI Number | 1093230138 |
|---|---|
| Provider Enumeration Date | 08/10/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 0547532996 |
|---|---|
| Medicare Enrollment ID | O20171222000408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093230138 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 9691 (Nevada) | Primary |
| Provider Name | Camilo Tabora |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265543458 PECOS PAC ID: 5193791036 Enrollment ID: I20050928000925 |
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