| Capistrano | |
|
2775 S Jones Blvd Ste 101 Las Vegas NV 89146-5632 | |
| (702) 685-3000 | |
| Not Available |
| Full Name | Capistrano |
|---|---|
| Speciality | Psychologist |
| Location | 2775 S Jones Blvd Ste 101, Las Vegas, Nevada |
| Authorized Official Name and Position | Ward Kent Swallow (PRESIDENT) |
| Authorized Official Contact | 7024814776 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capistrano 2775 S Jones Blvd Ste 101 Las Vegas NV 89146-5632 Ph: (702) 685-3000 | Capistrano 2775 S Jones Blvd Ste 101 Las Vegas NV 89146-5632 Ph: (702) 685-3000 |
| NPI Number | 1306638754 |
|---|---|
| Provider Enumeration Date | 05/21/2025 |
| Last Update Date | 05/13/2026 |
| Certification Date | 05/13/2026 |
| Medicare PECOS PAC ID | 2062927437 |
|---|---|
| Medicare Enrollment ID | O20250715001097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306638754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | () | Primary |
| Provider Name | Ward Kent Swallow |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871626564 PECOS PAC ID: 6507842630 Enrollment ID: I20040628001542 |
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