Provider Demographics
NPI:1710375159
Name:PARTIDA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PARTIDA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARTIDA CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-261-6707
Mailing Address - Street 1:PO BOX 34625
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-4625
Mailing Address - Country:US
Mailing Address - Phone:702-261-6707
Mailing Address - Fax:702-261-6744
Practice Address - Street 1:5757 WAYNE NEWTON BLVD
Practice Address - Street 2:TERMINAL 1 MEZZANINE LEVEL 2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89111-8037
Practice Address - Country:US
Practice Address - Phone:702-261-6707
Practice Address - Fax:702-261-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty