Organization
VEGAS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JINGLAN GUSTILO (MANAGER)
(702) 362-6373
Entity
Organization
Contact information
Practice address
5300 SPRING MOUNTAIN RD STE 112, LAS VEGAS, NV 89146-8724
(702) 362-6373
(702) 362-6420
Mailing address
5300 SPRING MOUNTAIN RD STE 112, LAS VEGAS, NV 89146-8724
(702) 362-6373
(702) 362-6420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/24/2019
Last updated
09/30/2025
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