NPIMap

Organization Active NPI

Genesis Medical Clinic LLC

  • Psychiatry Physician
  • Las Vegas, NV
National Provider Identifier
1386389732
Registry record updated Apr 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
GENESIS MEDICAL CLINIC LLC
Practice address
1372 Montezuma CT
Las Vegas, NV 89119-4513
Phone
(702) 981-4012
NPI assigned
Apr 30, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2022

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

Authorized official

Name
Yusleisy CollazoNPI 1356939185
Title
Owner
Phone
(702) 981-4012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

1372 Montezuma CT
Las Vegas, NV 89119-4513

Mailing address

1372 Montezuma CT
Las Vegas, NV 89119-4513
Phone (702) 981-4012

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1651276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651276800000",
    "number": "1386389732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1372 MONTEZUMA CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891194513",
            "telephone_number": "702-981-4012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1372 MONTEZUMA CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891194513",
            "telephone_number": "702-981-4012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-30",
        "last_updated": "2022-04-30",
        "certification_date": "2022-04-30",
        "status": "A",
        "authorized_official_last_name": "COLLAZO",
        "authorized_official_first_name": "YUSLEISY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-981-4012"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "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 30, 2022; 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.