1922733559 NPI number — OPTUM MEDICAL GROUP RHODES P C

Table of content: MISS KARRI LYNN TESHIMA JR. LMT (NPI 1215215991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922733559 NPI number — OPTUM MEDICAL GROUP RHODES P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTUM MEDICAL GROUP RHODES P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922733559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89133-5380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-579-3203
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-724-8787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLO
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
702-480-2550

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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