NPIMap

Organization Active NPI

Celestial Health Solutions

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1124731401
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CELESTIAL HEALTH SOLUTIONS
Practice address
2255 Renaissance Dr Ste B
Las Vegas, NV 89119-6795
Phone
(702) 500-1728
Fax
(702) 356-3102
NPI assigned
Jan 2, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

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

Authorized official

Name
Mary Grace Mendiola Carillo
Title
Director
Phone
(702) 569-7244

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

2255 Renaissance Dr Ste B
Las Vegas, NV 89119-6795

Mailing address

222 S Rainbow Blvd Ste 206
Las Vegas, NV 89145-5356
Phone (702) 500-1728

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230127002203 NV Part B Supplier - Clinic/Group Practice 8527439603 Receives reassigned benefits from 8 practitioners
Practice locations: Las Vegas, NV; Pahrump, NV

National Provider Directory

National Provider Directory

Locations

222 S Rainbow Blvd
Ste 206
Las Vegas, NV 89145
Phone (702) 500-1728

Practitioners & affiliated clinicians

Practitioners 9

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": "1672617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776902400000",
    "number": "1124731401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S RAINBOW BLVD STE 206",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891455356",
            "telephone_number": "702-500-1728",
            "fax_number": "702-356-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 RENAISSANCE DR STE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196795",
            "telephone_number": "702-500-1728",
            "fax_number": "702-356-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CELESTIAL HEALTH SOLUTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-02",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A",
        "authorized_official_last_name": "CARILLO",
        "authorized_official_first_name": "MARY GRACE",
        "authorized_official_middle_name": "MENDIOLA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "702-569-7244"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Apr 23, 2026; 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.