Provider Demographics
NPI:1265432793
Name:EZPELETA, CARLOS ESPINA (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ESPINA
Last Name:EZPELETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W. CHARLESTON BLVD. STE. 508
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2688
Mailing Address - Fax:702-671-6595
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
Practice Address - Country:US
Practice Address - Phone:702-383-6250
Practice Address - Fax:702-459-8497
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3534207R00000X
NV6958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200140601Medicaid
IL110059773OtherRAILROAD MEDICARE
IL0006127113OtherBCBS OF ILLINOIS
IL036084623Medicaid
IL0006127113OtherBCBS OF ILLINOIS
ILF27855Medicare UPIN
IL036084623Medicaid