Healthcare Provider Details

I. General information

NPI: 1417794249
Provider Name (Legal Business Name): AMPARO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 E FLAMINGO RD STE C
LAS VEGAS NV
89121-5208
US

IV. Provider business mailing address

2950 E FLAMINGO RD STE C
LAS VEGAS NV
89121-5208
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-6004
  • Fax: 702-566-6009
Mailing address:
  • Phone: 702-565-6004
  • Fax: 702-566-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE PARTIDA CORONA
Title or Position: OWNER / MEDICAL DIRECTOR
Credential: MD
Phone: 702-528-9828