MEDICARE: PSYCHGENESIS MEDICAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1265131676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHGENESIS MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	5695 OAK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1936
Country	:	US
Telephone Number	:	702-849-3767
Fax Number	:	702-441-1652

Provider Business Practice Location Address
First Line	:	5695 OAK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1936
Country	:	US
Telephone Number	:	702-849-3767
Fax Number	:	702-441-1652

Authorized Official
Title or Position	:	OWNER
Name	:	EVA MARIA RIVERA
Credential	:	NP-C
Telephone Number	:	702-849-3767

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	04/27/2026

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