Organization
PACIFICA HEALTHCARE PROVIDERS LLC
Active
Other names
CiTi MD
Organization subpart
No
Provider details
NPI number
Authorized official
IBIANDI MARQUETTI-VARONA (CEO)
(702) 685-7770
Entity
Organization
Contact information
Practice address
2755 E DESERT INN RD STE 180, LAS VEGAS, NV 89121-3694
(702) 602-5106
Mailing address
2755 E DESERT INN RD STE 180, LAS VEGAS, NV 89121-3694
(702) 602-5106
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V60071
NV MEDICARE
NV
05
—
V60071
—
NV
Enumeration date
04/21/2020
Last updated
04/18/2022
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