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NPI Code Detail

MEDICARE: VISITA MEDICAL, LLC.

MEDICARE: VISITA MEDICAL, LLC.
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1487192183
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISITA MEDICAL, LLC.
Provider Business Mailing Address
First Line : 1809 PLAZA DEL CORDERO
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102
Country : US
Telephone Number : 702-287-8172
Fax Number : 702-989-8434
Provider Business Practice Location Address
First Line : 1809 PLAZA DEL CORDERO
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102
Country : US
Telephone Number : 702-287-8172
Fax Number : 702-989-8434
Authorized Official
Title or Position : CEO
Name : MR. JAYJAY M JOSEPH
Credential : APRN
Telephone Number : 702-287-8172
Provider Enumeration Date : 02/02/2017
Last Update Date : 02/02/2017

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