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NPI Code Detail

MEDICARE: GENERATIONS MED CENTER LLC

MEDICARE: GENERATIONS MED CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1063961027
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENERATIONS MED CENTER LLC
Provider Business Mailing Address
First Line : 8225 W SAHARA AVE STE C
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-8929
Country : US
Telephone Number : 702-476-2899
Fax Number : 702-476-1575
Provider Business Practice Location Address
First Line : 8225 W SAHARA AVE STE C
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-8929
Country : US
Telephone Number : 725-251-6390
Fax Number : 725-251-6712
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : JENNIE INGUANZO
Credential :
Telephone Number : 702-476-2899
Provider Enumeration Date : 09/30/2016
Last Update Date : 08/14/2024

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Directions to “GENERATIONS MED CENTER LLC ” Practice Location

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