Provider Demographics
NPI:1093230138
Name:SOUTHERN NEVADA MEDICAL & PEDIATRICS ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTHERN NEVADA MEDICAL & PEDIATRICS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILO
Authorized Official - Middle Name:
Authorized Official - Last Name:TABORA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-968-0100
Mailing Address - Street 1:3301 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1835
Mailing Address - Country:US
Mailing Address - Phone:702-968-0100
Mailing Address - Fax:702-968-0104
Practice Address - Street 1:3301 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1835
Practice Address - Country:US
Practice Address - Phone:702-968-0100
Practice Address - Fax:702-968-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9691261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care