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NPI Code Detail

MEDICARE: DMC MEDICAL CLINIC LTD

MEDICARE: DMC MEDICAL CLINIC LTD
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
1363LP2300XPrimary Care Nurse Practitioner

General Provider Information

NPI Number : 1699374256
Entity Type Code : Organization
Provider Name (Legal Business Name) : DMC MEDICAL CLINIC LTD
Provider Business Mailing Address
First Line : 1706 W BONANZA RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4704
Country : US
Telephone Number : 702-631-6863
Fax Number : 702-631-6864
Provider Business Practice Location Address
First Line : 1706 W BONANZA RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4704
Country : US
Telephone Number : 702-631-6863
Fax Number : 702-631-6864
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : MARIO GODOY
Credential : CNP
Telephone Number : 702-631-6863
Provider Enumeration Date : 10/23/2020
Last Update Date : 03/09/2026

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Directions to “DMC MEDICAL CLINIC LTD ” Practice Location

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