Active NPI
Idl Medical Center LLC
- Community Health Worker
- Las Vegas, NV
National Provider Identifier
1396641171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Legal business name
- IDL MEDICAL CENTER LLC
- Practice address
- 5603 S Eastern Ave
Las Vegas, NV 89119-2322 - Phone
- (702) 701-6136
- NPI assigned
- Oct 17, 2026
- Last updated
- Oct 17, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ivana Lagonell Lagonell, CHW
- Title
- Owner
- Phone
- (702) 701-6136
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | NU | Primary |
Addresses
Primary practice location
5603 S Eastern Ave
Las Vegas, NV 89119-2322
Mailing address
68 Quiet Desert LN
Henderson, NV 89074-3233
Phone (702) 701-6136
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1792195200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1792195200000",
"number": "1396641171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68 QUIET DESERT LN",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890743233",
"telephone_number": "702-701-6136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5603 S EASTERN AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891192322",
"telephone_number": "702-701-6136"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IDL MEDICAL CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-10-17",
"last_updated": "2026-10-17",
"certification_date": "2026-10-17",
"status": "A",
"authorized_official_last_name": "LAGONELL",
"authorized_official_first_name": "IVANA",
"authorized_official_middle_name": "LAGONELL",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "702-701-6136",
"authorized_official_credential": "CHW"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NU",
"license": null,
"primary": true
}
],
"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 Oct 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.