Provider Demographics
NPI:1427032614
Name:CUSI, PRISCILLA MARTINEZ (MD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:MARTINEZ
Last Name:CUSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-4400
Mailing Address - Country:US
Mailing Address - Phone:702-791-9062
Mailing Address - Fax:702-224-6906
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9062
Practice Address - Fax:702-224-6906
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA715632084P0800X
NH83842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0104898YONH02OtherBC/BS/ANTHEM
NH020514928OtherTRICARE/HEALTHNET FEDERAL
NH2012292OtherCIGNA BEHAVIORAL HEALTH
NH004026OtherVALUE OPTIONS
NH103421OtherMHN/HMC
NH30201477Medicaid