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NPI Code Detail

MEDICARE: EASTERN PRIMARY CARE LLC

MEDICARE: EASTERN PRIMARY CARE 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1790531762
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERN PRIMARY CARE LLC
Provider Business Mailing Address
First Line : 6859 S EASTERN AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0003
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6859 S EASTERN AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0003
Country : US
Telephone Number : 702-830-0615
Fax Number :
Authorized Official
Title or Position : NURSE PRACTITIONER/OWNER
Name : MICHELE WIJANGCO
Credential : NP
Telephone Number : 702-830-0615
Provider Enumeration Date : 04/29/2024
Last Update Date : 04/29/2024

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Directions to “EASTERN PRIMARY CARE LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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