Provider Demographics
NPI:1598928806
Name:CARMEN ESPITIA MD PC
Entity Type:Organization
Organization Name:CARMEN ESPITIA MD PC
Other - Org Name:ADELANTE FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPITIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-647-2583
Mailing Address - Street 1:1640 E CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1826
Mailing Address - Country:US
Mailing Address - Phone:702-647-2583
Mailing Address - Fax:702-647-2511
Practice Address - Street 1:1640 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1826
Practice Address - Country:US
Practice Address - Phone:702-647-2583
Practice Address - Fax:702-647-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2011-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVBL246Medicare PIN