Organization
CENTERWELL SENIOR PRIMARY CARE (NV) PC
Active
Parent organization
CENTERWELL SENIOR PRIMARY CARE (NV) PC
Other names
Partners in Primary Care NV PC, CenterWell Senior Primary Care- South eastern
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
4813 S EASTERN AVE, LAS VEGAS, NV 89119-6188
(725) 231-9260
(833) 749-0364
Mailing address
4700 MILLENIA BLVD STE 650, ORLANDO, FL 32839-6013
(407) 447-7120
(407) 770-0661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250009832
—
NV
Enumeration date
05/20/2020
Last updated
02/15/2024
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