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NPI Code Detail

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (NV) PC

MEDICARE: CENTERWELL SENIOR PRIMARY CARE (NV) PC
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
1207RI0011XInterventional Cardiology Physician
2208D00000XGeneral Practice Physician
3207Q00000XFamily Medicine Physician
4207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1306469788
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERWELL SENIOR PRIMARY CARE (NV) PC
Provider Business Mailing Address
First Line : 4700 MILLENIA BLVD STE 650
Second Line :
City : ORLANDO
State : FL
Zip : 32839-6013
Country : US
Telephone Number : 407-447-7120
Fax Number : 407-770-0661
Provider Business Practice Location Address
First Line : 2875 S NELLIS BLVD STE 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-2087
Country : US
Telephone Number : 702-843-2420
Fax Number : 833-749-0351
Authorized Official
Title or Position : SENIOR CREDENTIALING PROFESSIONAL
Name : ANGIE MARTINEZ
Credential :
Telephone Number : 407-447-7120
Provider Enumeration Date : 05/20/2020
Last Update Date : 02/15/2024

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Directions to “CENTERWELL SENIOR PRIMARY CARE (NV) PC ” Practice Location

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