Provider Demographics
NPI:1639205164
Name:ABELLA, EMERITA BACATAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EMERITA
Middle Name:BACATAN
Last Name:ABELLA
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 1:6638 TRANQUIL SEAS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5332
Mailing Address - Country:US
Mailing Address - Phone:702-987-1545
Mailing Address - Fax:
Practice Address - Street 1:61 N NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5330
Practice Address - Country:US
Practice Address - Phone:702-383-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7133208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1202877Medicaid
NV1202877Medicaid
NV31866Medicare ID - Type Unspecified