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NPI Code Detail

MEDICARE: JGBB LLC

MEDICARE: JGBB 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
1261QH0100XHealth Service Clinic/Center
2164W00000XLicensed Practical Nurse
3163WI0500XInfusion Therapy Registered Nurse
4261Q00000XClinic/Center
5163WH0200XHome Health Registered Nurse
6332BN1400XNursing Facility Supplies (DME)
7163WA2000XAdministrator Registered Nurse
8163WP2201XAmbulatory Care Registered Nurse
9261QP2400XPrison Health Clinic/Center
10261QI0500XInfusion Therapy Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659846699
Entity Type Code : Organization
Provider Name (Legal Business Name) : JGBB LLC
Provider Business Mailing Address
First Line : 801 S RANCHO DR STE D1-B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3854
Country : US
Telephone Number : 702-825-4900
Fax Number : 702-977-8150
Provider Business Practice Location Address
First Line : 801 S RANCHO DR STE D1-B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3854
Country : US
Telephone Number : 702-478-5133
Fax Number : 702-478-5401
Authorized Official
Title or Position : ADMINISTRATOR
Name : TERESA PATAWARAN BUCO
Credential : RN
Telephone Number : 702-790-4404
Provider Enumeration Date : 10/05/2018
Last Update Date : 01/13/2026

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Directions to “JGBB LLC ” Practice Location

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