MEDICARE: AGREDA HEALTH 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	207R00000X	Internal Medicine Physician
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1639021165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGREDA HEALTH LLC

Provider Business Mailing Address
First Line	:	8560 S EASTERN AVE STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2848
Country	:	US
Telephone Number	:	702-883-6821
Fax Number	:	702-268-8776

Provider Business Practice Location Address
First Line	:	8560 S EASTERN AVE STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2848
Country	:	US
Telephone Number	:	702-883-6821
Fax Number	:	702-268-8776

Authorized Official
Title or Position	:	MEMBER
Name	:	RALPH MESA
Credential	:
Telephone Number	:	725-500-4503

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/15/2026

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Directions to “AGREDA HEALTH LLC ” Practice Location

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