MEDICARE: ANNA CAROLL PINELO COLL CARDENAS MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RI0200X	Infectious Disease Physician	25189	NV

General Provider Information

NPI Number	:	1508425950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA CAROLL PINELO COLL CARDENAS MD

Provider Business Mailing Address
First Line	:	4335 S GRAND CANYON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7183
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4335 S GRAND CANYON DR UNIT 183
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7187
Country	:	US
Telephone Number	:	716-418-9956
Fax Number	:

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

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	10/20/2025

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