Provider Demographics
NPI:1073394748
Name:ARK MEDICAL OF LAS VEGAS LLC
Entity Type:Organization
Organization Name:ARK MEDICAL OF LAS VEGAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:619-259-7118
Mailing Address - Street 1:7521 SLIPPER ORCHID ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2616
Mailing Address - Country:US
Mailing Address - Phone:619-259-7118
Mailing Address - Fax:
Practice Address - Street 1:2820 W CHARLESTON BLVD STE D40
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1942
Practice Address - Country:US
Practice Address - Phone:725-205-0288
Practice Address - Fax:725-204-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty