Provider Demographics
NPI:1235105313
Name:ONTANILLAS, MAJONEL (MD)
Entity Type:Individual
Prefix:
First Name:MAJONEL
Middle Name:
Last Name:ONTANILLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-243-8500
Mailing Address - Fax:702-242-4194
Practice Address - Street 1:2704 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0424
Practice Address - Country:US
Practice Address - Phone:702-243-8500
Practice Address - Fax:702-242-4194
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223130207R00000X
NV12413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1235105313Medicaid
J28398OtherBLUE SHIELD INDEMNITY
AA22681OtherHARVARD PILGRIM
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
419302OtherTUFTS HEALTH PLAN
042472266OtherONE HEALTH PLAN
A38033OtherMEDICARE B
042472266OtherUNITED HEALTHCARE
1919739OtherFIRST HEALTH
7398225OtherAETNA US HEALTHCARE
J28398OtherBLUE SHIELD HMO BLUE
2091283OtherMEDICAID WELFARE
MA2091283Medicaid
784170OtherMVP HEALTH CARE
91262OtherFALLON COMMUNITY HEALTH
J28398OtherBLUE CARE ELECT
4714498OtherCIGNA HEALTH PLAN
H33344Medicare UPIN
J28398OtherBLUE SHIELD INDEMNITY
042472266OtherTHREE RIVERS
1919739OtherFIRST HEALTH
419302OtherTUFTS HEALTH PLAN