Active NPI
Samuel Antonio Mujica Trenche, MD
- Pediatrics Physician
- Las Vegas, NV
National Provider Identifier
1366444937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 5456
- Practice address
- 3265 Rosanna St
Las Vegas, NV 89117-3137 - Phone
- (702) 205-1948
- Fax
- (702) 876-9181
- NPI assigned
- Aug 12, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5456 | NV | Primary |
Addresses
Primary practice location
3265 Rosanna St
Las Vegas, NV 89117-3137
Mailing address
3265 Rosanna St
Las Vegas, NV 89117-3137
Phone (702) 205-1948
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002002938 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111215000730 | CA | Order and Referring Only - Pediatric Medicine | 5597749283 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200528000000",
"number": "1366444937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3265 ROSANNA ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891173137",
"telephone_number": "702-205-1948",
"fax_number": "702-876-9181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3265 ROSANNA ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891173137",
"telephone_number": "702-205-1948",
"fax_number": "702-876-9181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUJICA TRENCHE",
"first_name": "SAMUEL",
"middle_name": "ANTONIO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-12",
"last_updated": "2008-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NV",
"license": "5456",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002002938",
"state": "NV"
}
],
"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 Jan 17, 2008; 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.