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General NPI Number Information
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NPI Number | 1265131676
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Entity Type | Organization
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Legal Business Name | PSYCHGENESIS MEDICAL, PLLC
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 5695 OAK ST
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City | LAS VEGAS
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State | NV
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Zip | 89120-1936
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Country | US
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Telephone | 702-849-3767
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Fax | 702-441-1652
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Provider Business Mailing Address
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Address Line | 5695 OAK ST
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City | LAS VEGAS
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State | NV
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Zip | 89120-1936
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Country | US
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Telephone | 702-849-3767
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Fax | 702-441-1652
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Authorized Official
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Title or Position | OWNER
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Name | EVA MARIA RIVERA
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Credential | NP-C
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Telephone | 702-849-3767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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