Provider Demographics
NPI:1609327931
Name:ANGELES MEDICAL CENTERS LLC
Entity Type:Organization
Organization Name:ANGELES MEDICAL CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTINEZ-MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-335-5022
Mailing Address - Street 1:840 N DECATUR BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1905
Mailing Address - Country:US
Mailing Address - Phone:702-333-0110
Mailing Address - Fax:702-333-0442
Practice Address - Street 1:840 N DECATUR BLVD
Practice Address - Street 2:STE. A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1905
Practice Address - Country:US
Practice Address - Phone:702-333-0110
Practice Address - Fax:702-333-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty