1992995021 NPI number — JALET MARIE N ONTANILLAS M.D.

Table of content: JALET MARIE N ONTANILLAS M.D. (NPI 1992995021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992995021 NPI number — JALET MARIE N ONTANILLAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ONTANILLAS
Provider First Name:
JALET MARIE
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1992995021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8352 W WARM SPRINGS RD STE 210
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:
89113-3630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-944-4028
Provider Business Mailing Address Fax Number:
702-944-4019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8352 W WARM SPRINGS DR. #210
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:
89113-3630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-944-4028
Provider Business Practice Location Address Fax Number:
702-944-4019
Provider Enumeration Date:
07/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  12425 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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