=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124609524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ILIAD AND ODYSSEY BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2021
-----------------------------------------------------
Last Update Date | 03/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3130 S RAINBOW BLVD STE 301
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-6212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-262-0110
-----------------------------------------------------
Fax | 702-444-7898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 400546 C/O HOMER TUAZON
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | HOMER TUAZON
-----------------------------------------------------
Credential | DNP, APRN,FNP, PMHNP
-----------------------------------------------------
Telephone | 702-417-3865
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------