Provider Demographics
NPI:1508486317
Name:PACIFICA HEALTHCARE PROVIDERS LLC
Entity Type:Organization
Organization Name:PACIFICA HEALTHCARE PROVIDERS LLC
Other - Org Name:CITI MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IBIANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUETTI-VARONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-685-7770
Mailing Address - Street 1:2755 E DESERT INN RD STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3694
Mailing Address - Country:US
Mailing Address - Phone:702-602-5106
Mailing Address - Fax:
Practice Address - Street 1:2755 E DESERT INN RD STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3694
Practice Address - Country:US
Practice Address - Phone:702-602-5106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV60071OtherNV MEDICARE
NVV60071Medicaid