Provider Demographics
NPI:1790009025
Name:MAUPIN, CAMELA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAMELA
Middle Name:
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 S FORT APACHE RD
Mailing Address - Street 2:STE 215-232
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1719
Mailing Address - Country:US
Mailing Address - Phone:702-798-0111
Mailing Address - Fax:844-247-3481
Practice Address - Street 1:2704 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0424
Practice Address - Country:US
Practice Address - Phone:702-243-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00869987OtherRAILROAD MEDICARE
NV1790009025Medicaid
NVV50651OtherSMA MEDICARE
NVP00869987OtherRAILROAD MEDICARE
NVDG352XMedicare PIN