MEDICARE: ANGELES MEDICAL CENTERS 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	363LF0000X	Family Nurse Practitioner	APRN002705	NV

General Provider Information

NPI Number	:	1609389394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELES MEDICAL CENTERS LLC

Provider Business Mailing Address
First Line	:	2123 CIVIC CENTER DR
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-6327
Country	:	US
Telephone Number	:	702-333-0110
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 CIVIC CENTER DRIVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030
Country	:	US
Telephone Number	:	702-333-0110
Fax Number	:	702-333-0442

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ALEJANDRA CEJA
Credential	:
Telephone Number	:	702-333-0110

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	12/11/2025

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