# EASTERN PRIMARY CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790531762
- **Authorized official:** MICHELE WIJANGCO NP (NURSE PRACTITIONER/OWNER)
- **Authorized official phone:** (702) 830-0615

## Contact information

- **Practice address:** 6859 S EASTERN AVE STE 103, LAS VEGAS, NV 89119-0003
- **Practice address phone:** (702) 830-0615
- **Mailing address:** 6859 S EASTERN AVE STE 103, LAS VEGAS, NV 89119-0003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/29/2024
- **Last updated:** 04/29/2024