Healthcare Provider Details

I. General information

NPI: 1710813787
Provider Name (Legal Business Name): PECOS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 E WARM SPRINGS RD STE 110
LAS VEGAS NV
89120-3188
US

IV. Provider business mailing address

3235 E WARM SPRINGS RD STE 110
LAS VEGAS NV
89120-3188
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-5900
  • Fax: 702-329-7603
Mailing address:
  • Phone: 775-299-4787
  • Fax: 775-299-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADEDAYO O MOKUOLU
Title or Position: PRESIDENT
Credential: MD
Phone: 775-299-4787