Provider Demographics
NPI:1508967605
Name:CARRERA, ELADIO (MD)
Entity Type:Individual
Prefix:
First Name:ELADIO
Middle Name:
Last Name:CARRERA
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 34795
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-4795
Mailing Address - Country:US
Mailing Address - Phone:702-220-9865
Mailing Address - Fax:702-251-8196
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 525
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-220-9865
Practice Address - Fax:702-251-8196
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5165207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1508967605Medicaid
NVCM262YMedicare PIN
NVCM262YMedicare PIN