| Well Care Medical Group Of North Las Vegas Incorporated | |
|
4130 N Mlk Blvd Ste A North Las Vegas NV 89032-0299 | |
| (702) 764-4868 | |
| Not Available |
| Full Name | Well Care Medical Group Of North Las Vegas Incorporated |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4130 N Mlk Blvd Ste A, North Las Vegas, Nevada |
| Authorized Official Name and Position | Neneth Suarez (PRESIDENT) |
| Authorized Official Contact | 7027644868 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Well Care Medical Group Of North Las Vegas Incorporated 6565 Spencer St Ste 102 Las Vegas NV 89119-3924 Ph: (725) 275-6970 | Well Care Medical Group Of North Las Vegas Incorporated 4130 N Mlk Blvd Ste A North Las Vegas NV 89032-0299 Ph: (702) 764-4868 |
| NPI Number | 1588389944 |
|---|---|
| Provider Enumeration Date | 10/07/2022 |
| Last Update Date | 07/17/2024 |
| Medicare PECOS PAC ID | 9931555489 |
|---|---|
| Medicare Enrollment ID | O20231019003197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588389944 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Primary |
| Provider Name | Daniel Sussman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275575870 PECOS PAC ID: 7214832179 Enrollment ID: I20040625000223 |
| Provider Name | Teodora B Del Pilar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992195523 PECOS PAC ID: 5890096481 Enrollment ID: I20151228001143 |
| Provider Name | Ruel L Mariano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114481785 PECOS PAC ID: 3476893504 Enrollment ID: I20190327001362 |
| Provider Name | Deja Fuimaono |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497028682 PECOS PAC ID: 4385079748 Enrollment ID: I20200114001333 |
| Provider Name | Reynante Villahermosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649878828 PECOS PAC ID: 0143636977 Enrollment ID: I20210303000329 |
| Provider Name | Angelica Villahermosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912505199 PECOS PAC ID: 8628484805 Enrollment ID: I20210312002041 |
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