MEDICARE: DR. ELLAINE SESE PINGOL 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	207Q00000X	Family Medicine Physician	10301	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1679576060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLAINE SESE PINGOL MD

Provider Business Mailing Address
First Line	:	PO BOX 531465
Second Line	:	HENDERSON
City	:	HENDERSON
State	:	NV
Zip	:	89053-1465
Country	:	US
Telephone Number	:	702-837-4397
Fax Number	:	702-837-7426

Provider Business Practice Location Address
First Line	:	10001 S EASTERN AVE STE 210
Second Line	:	HENDERSON
City	:	HENDERSON
State	:	NV
Zip	:	89052-3908
Country	:	US
Telephone Number	:	702-837-4397
Fax Number	:	702-837-7426

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/04/2010

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