| Bamboo Family Clinic Llc | |
|
98 E Lake Mead Pkwy Ste 307 Henderson NV 89015-6444 | |
| (702) 433-3038 | |
| (702) 949-1975 |
| Full Name | Bamboo Family Clinic Llc |
|---|---|
| Speciality | Pediatrics |
| Location | 98 E Lake Mead Pkwy Ste 307, Henderson, Nevada |
| Authorized Official Name and Position | Shirley Holdeman (OWNER) |
| Authorized Official Contact | 7024333038 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bamboo Family Clinic Llc Po Box 13603 Las Vegas NV 89112-1603 Ph: (702) 433-3038 | Bamboo Family Clinic Llc 98 E Lake Mead Pkwy Ste 307 Henderson NV 89015-6444 Ph: (702) 433-3038 |
| NPI Number | 1881196012 |
|---|---|
| Provider Enumeration Date | 03/03/2018 |
| Last Update Date | 03/03/2018 |
| Medicare PECOS PAC ID | 9830565498 |
|---|---|
| Medicare Enrollment ID | O20221021002572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881196012 | NPI | - | NPPES |
| Provider Name | Marilyn J Tuiasosopo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629733704 PECOS PAC ID: 3476930231 Enrollment ID: I20220517000511 |
| Provider Name | Jenna Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255903498 PECOS PAC ID: 1355718669 Enrollment ID: I20221028002505 |
| Provider Name | Maricel Raymundo Leppala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255038451 PECOS PAC ID: 9931564440 Enrollment ID: I20230504002068 |
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