MEDICARE: REALCARE WELLNESS 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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1134097058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REALCARE WELLNESS LLC

Provider Business Mailing Address
First Line	:	732 S 6TH ST # 8014
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	725-772-1939
Fax Number	:	702-442-4665

Provider Business Practice Location Address
First Line	:	732 S 6TH ST # 8014
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	725-772-1939
Fax Number	:	702-442-4665

Authorized Official
Title or Position	:	NURSE PRACTITIONER/OWNER
Name	:	MARK MAXILOM POLINTAN
Credential	:	APRN, FNP-C
Telephone Number	:	725-772-1939

Provider Enumeration Date	:	10/24/2025
Last Update Date	:	10/24/2025

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