Healthcare Provider Details

I. General information

NPI: 1609389394
Provider Name (Legal Business Name): ANGELES MEDICAL CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 CIVIC CENTER DRIVE
NORTH LAS VEGAS NV
89030
US

IV. Provider business mailing address

2123 CIVIC CENTER DR
N LAS VEGAS NV
89030-6327
US

V. Phone/Fax

Practice location:
  • Phone: 702-333-0110
  • Fax: 702-333-0442
Mailing address:
  • Phone: 702-333-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002705
License Number StateNV

VIII. Authorized Official

Name: ALEJANDRA CEJA
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-333-0110