| Innotiv Germin | |
|
1691 W Horizon Ridge Pkwy #100 Henderson NV 89012-3494 | |
| (702) 804-1212 | |
| (702) 804-1222 |
| Full Name | Innotiv Germin |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1691 W Horizon Ridge Pkwy, Henderson, Nevada |
| Authorized Official Name and Position | Leo Germin (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7028041212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innotiv Germin Po Box 530786 Henderson NV 89053-0786 Ph: (702) 804-1212 | Innotiv Germin 1691 W Horizon Ridge Pkwy #100 Henderson NV 89012-3494 Ph: (702) 804-1212 |
| NPI Number | 1225101330 |
|---|---|
| Provider Enumeration Date | 11/16/2006 |
| Last Update Date | 01/20/2016 |
| Medicare PECOS PAC ID | 3476844259 |
|---|---|
| Medicare Enrollment ID | O20160627000281 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225101330 | NPI | - | NPPES |
| 002019758 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 7866 (Nevada) | Primary |
| Provider Name | Leo Germin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013928886 PECOS PAC ID: 2163401795 Enrollment ID: I20070202000461 |
| Provider Name | Fara Mae K Tan |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1588045850 PECOS PAC ID: 9234445545 Enrollment ID: I20150901002800 |
| Provider Name | Jessica A Knirk |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1194933465 PECOS PAC ID: 2567643125 Enrollment ID: I20160608002082 |
| Provider Name | William B Lujan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588644355 PECOS PAC ID: 6901859578 Enrollment ID: I20180813000799 |
| Provider Name | Christina Lynn Galon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063983682 PECOS PAC ID: 6204177173 Enrollment ID: I20190403001885 |
| Provider Name | Eric Gutglueck |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1184011330 PECOS PAC ID: 8224453956 Enrollment ID: I20200729000593 |
| Provider Name | Anup Panduranga |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1316108202 PECOS PAC ID: 2365696697 Enrollment ID: I20221123002037 |
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