1831853159 NPI number — CHRISTINA MARIE CAMAT MEDRANO WEINRICK

Table of content: CHRISTINA MARIE CAMAT MEDRANO WEINRICK (NPI 1831853159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831853159 NPI number — CHRISTINA MARIE CAMAT MEDRANO WEINRICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDRANO WEINRICK
Provider First Name:
CHRISTINA MARIE
Provider Middle Name:
CAMAT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEINRICK
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
MEDRANO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831853159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370251, 1611 SPRING GATE LANE
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:
89134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-738-1373
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 E WARM SPRINGS RD
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:
89119-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-659-9090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2021

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: 363L00000X , with the licence number:  837570 , 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)





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