Camilo Bernal Tabora Jr., M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9691 Issued in NV

Practice address

3301 W Charleston Blvd
Las Vegas, NV 89102-1835

Phone

(702) 968-0100

Fax

(702) 968-0104

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: camilo.tabora.1@15442.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Nevada Medical & Pediatrics Associates LLC

  • Primary Care Clinic/Center
  • Las Vegas, NV
  • NPI 1093230138
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1265543458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021835",
            "telephone_number": "702-968-0100",
            "fax_number": "702-968-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021835",
            "telephone_number": "702-968-0100",
            "fax_number": "702-968-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABORA",
        "first_name": "CAMILO",
        "middle_name": "BERNAL",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "9691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018735",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shellylin Tabladillo
• Julieta G Tablante-Blanco, MD
• Angela Laczell Tabor
• Anthony Tabor, D.P.T.
• Lisa Katherine Tabor, APRN, ACNP-BC
• Loreta Tabrane
• Arthur Tabrizi
• Maryam Tabrizi, DMD-MPH
• Erwin Johann Librodo Tabucanon, MD
• Chaisy Tabula, PHARMD

• Internal Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.