Healthcare Provider Details

I. General information

NPI: 1255263356
Provider Name (Legal Business Name): CENTERWELL SENIOR PRIMARY CARE NV CS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ANTHEM VILLAGE DR STE 100
HENDERSON NV
89052-5562
US

IV. Provider business mailing address

2500 ANTHEM VILLAGE DR STE 100
HENDERSON NV
89052-5562
US

V. Phone/Fax

Practice location:
  • Phone: 702-843-1437
  • Fax: 702-832-5775
Mailing address:
  • Phone: 702-843-1437
  • Fax: 702-832-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGIE MARTINEZ
Title or Position: SENIOR CREDENTIALING PROFESSIONAL
Credential:
Phone: 407-447-7120