Healthcare Provider Details

I. General information

NPI: 1174268429
Provider Name (Legal Business Name): JGBB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7151 CASCADE VALLEY CT UNIT 101102 UNIT 101 AND 102
LAS VEGAS NV
89128-0496
US

IV. Provider business mailing address

801 S RANCHO DR STE D1-B
LAS VEGAS NV
89106-3854
US

V. Phone/Fax

Practice location:
  • Phone: 702-825-4900
  • Fax:
Mailing address:
  • Phone: 702-587-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA PATAWARAN BUCO
Title or Position: REGIONAL MANAGER
Credential: RN
Phone: 702-478-5133