Provider Demographics
NPI:1851766117
Name:HOMER C TUAZON LLC
Entity Type:Organization
Organization Name:HOMER C TUAZON LLC
Other - Org Name:APOLLO MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUAZON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNPC
Authorized Official - Phone:702-417-3865
Mailing Address - Street 1:PO BOX 400546
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0546
Mailing Address - Country:US
Mailing Address - Phone:702-444-7744
Mailing Address - Fax:702-444-7898
Practice Address - Street 1:3110 E SUNSET RD STE K
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-5700
Practice Address - Country:US
Practice Address - Phone:702-444-7744
Practice Address - Fax:702-444-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8770174400000X, 2471C3402X
NVAPRN001431363LF0000X
363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty