| Renaissance Medical Group | |
|
2870 S Maryland Pkwy Las Vegas NV 89109-5031 | |
| (718) 344-3446 | |
| Not Available |
| Full Name | Renaissance Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 2870 S Maryland Pkwy, Las Vegas, Nevada |
| Authorized Official Name and Position | Beatriz Ang-ermocilla (OWNER) |
| Authorized Official Contact | 7183446298 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renaissance Medical Group 7508 Via Signorelli St Las Vegas NV 89131-0125 | Renaissance Medical Group 2870 S Maryland Pkwy Las Vegas NV 89109-5031 Ph: (718) 344-3446 |
| NPI Number | 1528871357 |
|---|---|
| Provider Enumeration Date | 01/27/2025 |
| Last Update Date | 01/27/2025 |
| Certification Date | 01/27/2025 |
| Medicare PECOS PAC ID | 5799290128 |
|---|---|
| Medicare Enrollment ID | O20250715002427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528871357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| Provider Name | Carlos a Ermocilla |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1497799407 PECOS PAC ID: 4385682905 Enrollment ID: I20050422000749 |
| Provider Name | Beatriz L Ang-ermocilla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962412106 PECOS PAC ID: 0840241287 Enrollment ID: I20110325000593 |
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