Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Centerwell Senior Primary Care (Nv) PC

Organization Family Medicine Physician · NPI 1003695545

Centerwell Senior Primary Care (Nv) PC is a Family Medicine Physician in Las Vegas, Nevada. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
4
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

691 N Nellis Blvd
Las Vegas, NV 89110-5383
Phone: (702) 430-9996
Fax: (877) 409-2125
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Family Medicine Physician Taxonomy 207Q00000X
Interventional Cardiology Physician Taxonomy 207RI0011X
General Practice Physician Taxonomy 208D00000X

Record details

NPI number1003695545
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationCenterwell Senior Primary Care (Nv) PC
Authorized official Angie Martinez — Senior Credentialing Professional · (407) 447-7120
Other names Centerwell Senior Primary Care-Bonanza; Centerwell Senior Primary Care-Bonanza
NPI enumeratedSeptember 25, 2023
Last updated in NPPESJuly 3, 2024
Certification dateJuly 3, 2024
Mailing address6101 Blue Lagoon Dr Ste 200, Miami, FL 33126-3168

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