Provider Demographics
NPI:1205024437
Name:CARLOS T. TISBE, M.D., PLLC
Entity Type:Organization
Organization Name:CARLOS T. TISBE, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:T
Authorized Official - Last Name:TISBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-454-8236
Mailing Address - Street 1:3230 E FLAMINGO RD
Mailing Address - Street 2:334
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4320
Mailing Address - Country:US
Mailing Address - Phone:702-454-8236
Mailing Address - Fax:702-454-8279
Practice Address - Street 1:3230 E FLAMINGO RD
Practice Address - Street 2:334
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4320
Practice Address - Country:US
Practice Address - Phone:702-454-8236
Practice Address - Fax:702-454-8279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10770207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV01609049Medicaid
NV01609049Medicaid