Organization
CENTERWELL SENIOR PRIMARY CARE (NV) PC
Active
Organization
CENTERWELL SENIOR PRIMARY CARE (NV) PC
Active
Parent organization
CENTERWELL SENIOR PRIMARY CARE (NV) PC
Other names
CenterWell Senior Primary Care-Bonanza
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTERWELL SENIOR PRIMARY CARE (NV) PC
Authorized official
ANGIE MARTINEZ (SENIOR CREDENTIALING PROFESSIONAL)
(407) 447-7120
Entity
Organization
Contact information
Practice address
691 N NELLIS BLVD, LAS VEGAS, NV 89110-5383
(702) 430-9996
(877) 409-2125
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(305) 500-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
09/25/2023
Last updated
07/03/2024
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