MEDICARE: GOOD CHOICE PEDIATRICS 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	208000000X	Pediatrics Physician	10268	NV

General Provider Information

NPI Number	:	1386962322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD CHOICE PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	3050 E BONANZA RD
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 E BONANZA RD
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3703
Country	:	US
Telephone Number	:	615-672-5953
Fax Number	:	270-751-0405

Authorized Official
Title or Position	:	OWNER
Name	:	ANSLEM OPARAUGO
Credential	:	MD
Telephone Number	:	702-858-8773

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	08/20/2020

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