MEDICARE: PARTIDA MEDICAL CENTER 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	11639	NV

General Provider Information

NPI Number	:	1710375159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTIDA MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 34625
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-4625
Country	:	US
Telephone Number	:	702-261-6707
Fax Number	:	702-261-6744

Provider Business Practice Location Address
First Line	:	5757 WAYNE NEWTON BLVD
Second Line	:	TERMINAL 1 MEZZANINE LEVEL 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89111-8037
Country	:	US
Telephone Number	:	702-261-6707
Fax Number	:	702-261-6744

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSE M PARTIDA CORONA
Credential	:	M.D.
Telephone Number	:	702-261-6707

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	03/31/2016

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