MEDICARE: NEVADA ALWAYS YOUR DOCTOR 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	261Q00000X	Clinic/Center
2	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1497432793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA ALWAYS YOUR DOCTOR LLC.

Provider Business Mailing Address
First Line	:	4580 S EASTERN AVE STE 29
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6100
Country	:	US
Telephone Number	:	702-826-0956
Fax Number	:

Provider Business Practice Location Address
First Line	:	4580 S EASTERN AVE STE 29
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6100
Country	:	US
Telephone Number	:	702-826-0956
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THERESA SIMPORIOS MONTECILLO
Credential	:	NURSE PRACTITIONER
Telephone Number	:	702-826-0959

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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Directions to “NEVADA ALWAYS YOUR DOCTOR LLC. ” Practice Location

Language	Start Address	Practice Location

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