Sta Maria Pediatric Clinic LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

STA MARIA PEDIATRIC CLINIC LLC

Practice address

730 N Eastern Ave
Ste 100
Las Vegas, NV 89101-2885

Phone

(702) 388-4428

Fax

(702) 388-4312

NPI assigned

Mar 29, 2014

Organization subpart

No

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

Authorized official

Name

Teresita Lu Melocoton, MD

Title

Manager

Phone

(702) 388-4428

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1396051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396915200000",
    "number": "1104244011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 W CHARLESTON BLVD",
            "address_2": "STE 210",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021900",
            "telephone_number": "702-388-4428",
            "fax_number": "702-388-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 N EASTERN AVE",
            "address_2": "STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891012885",
            "telephone_number": "702-388-4428",
            "fax_number": "702-388-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STA MARIA PEDIATRIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-29",
        "last_updated": "2014-04-08",
        "status": "A",
        "authorized_official_last_name": "MELOCOTON",
        "authorized_official_first_name": "TERESITA",
        "authorized_official_middle_name": "LU",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-388-4428",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Pediatrics Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.