MEDICARE: CLINICA SANTA MARIA 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	207Q00000X	Family Medicine Physician	14003243100349	NV

General Provider Information

NPI Number	:	1972697712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA SANTA MARIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 36340
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-6340
Country	:	US
Telephone Number	:	702-735-1960
Fax Number	:

Provider Business Practice Location Address
First Line	:	2354 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3451
Country	:	US
Telephone Number	:	702-399-9161
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ROBERT JOSEPH WEBB
Credential	:
Telephone Number	:	702-399-9161

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/06/2011

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Directions to “CLINICA SANTA MARIA LLC ” Practice Location

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