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NPI Code Detail

MEDICARE: DESERT PRIMARY CARE PLLC

MEDICARE: DESERT PRIMARY CARE PLLC
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
1261QM1300XMulti-Specialty Clinic/Center
2363L00000XNurse Practitioner
3363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1396454070
Entity Type Code : Organization
Provider Name (Legal Business Name) : DESERT PRIMARY CARE PLLC
Provider Business Mailing Address
First Line : 5233 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2311
Country : US
Telephone Number : 702-878-9500
Fax Number : 702-878-8993
Provider Business Practice Location Address
First Line : 5233 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2311
Country : US
Telephone Number : 702-878-9500
Fax Number :
Authorized Official
Title or Position : MANAGING DIRECTOR
Name : REENA JOHN
Credential :
Telephone Number : 702-878-9500
Provider Enumeration Date : 11/21/2022
Last Update Date : 05/15/2023

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Directions to “DESERT PRIMARY CARE PLLC ” Practice Location

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