Organization Active NPI

Well Care Medical LLC

  • Psychiatry Physician
  • Las Vegas, NV
National Provider Identifier
1073296851
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
WELL CARE MEDICAL LLC
Practice address
3230 E Charleston Blvd Ste 111
Las Vegas, NV 89104-6627
Phone
(702) 724-4876
NPI assigned
Aug 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeniffer Marino Gonzalez
Title
Owner
Phone
(702) 724-4876

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3230 E Charleston Blvd Ste 111
Las Vegas, NV 89104-6627

Mailing address

3230 E Charleston Blvd Ste 111
Las Vegas, NV 89104-6627
Phone (702) 724-4876

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240524002961 NV Part B Supplier - Clinic/Group Practice 3274975016 Receives reassigned benefits from 2 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

1505 S Maryland Pkwy
Las Vegas, NV 89104
Phone (702) 755-9305

3230 E Charleston Blvd
Ste 11
Las Vegas, NV 89104

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756339200000",
    "number": "1073296851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3230 E CHARLESTON BLVD STE 111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891046627",
            "telephone_number": "702-724-4876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3230 E CHARLESTON BLVD STE 111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891046627",
            "telephone_number": "702-724-4876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELL CARE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-09",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A",
        "authorized_official_last_name": "MARINO GONZALEZ",
        "authorized_official_first_name": "JENIFFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-724-4876"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.