MEDICARE: DR. CARLOS ESPINA EZPELETA M.D.

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	207R00000X	Internal Medicine Physician	M3534	TX
2	207R00000X	Internal Medicine Physician	6958	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110059773	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0006127113	OTHER	IL	BCBS OF ILLINOIS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265432793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS ESPINA EZPELETA M.D.

Provider Business Mailing Address
First Line	:	1800 W. CHARLESTON BLVD. STE. 508
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-383-2688
Fax Number	:	702-671-6595

Provider Business Practice Location Address
First Line	:	61 N. NELLIS BLVD.
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110
Country	:	US
Telephone Number	:	702-383-6250
Fax Number	:	702-459-8497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	10/24/2018

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Directions to “ DR. CARLOS ESPINA EZPELETA M.D.” Practice Location

Language	Start Address	Practice Location

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