Provider Demographics
NPI:1073087581
Name:LAKE MEAD PEDIATRICS, LLC.
Entity Type:Organization
Organization Name:LAKE MEAD PEDIATRICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESITA
Authorized Official - Last Name:ZAGALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-489-5748
Mailing Address - Street 1:129 W LAKE MEAD PKWY STE 10
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7055
Mailing Address - Country:US
Mailing Address - Phone:702-489-5748
Mailing Address - Fax:702-489-5774
Practice Address - Street 1:129 W LAKE MEAD PKWY STE 10
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7055
Practice Address - Country:US
Practice Address - Phone:702-489-5748
Practice Address - Fax:702-489-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty