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General NPI Number Information
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NPI Number | 1710375159
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Entity Type | Organization
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Legal Business Name | PARTIDA MEDICAL CENTER LLC
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 5757 WAYNE NEWTON BLVD TERMINAL 1 MEZZANINE LEVEL 2
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City | LAS VEGAS
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State | NV
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Zip | 89111-8037
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Country | US
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Telephone | 702-261-6707
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Fax | 702-261-6744
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Provider Business Mailing Address
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Address Line | PO BOX 34625
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City | LAS VEGAS
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State | NV
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Zip | 89133-4625
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Country | US
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Telephone | 702-261-6707
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Fax | 702-261-6744
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSE M PARTIDA CORONA
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Credential | M.D.
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Telephone | 702-261-6707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 11639
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License Number State | NV
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