Pacifica Healthcare Providers LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PACIFICA HEALTHCARE PROVIDERS LLC

Doing business as

CiTi MD

Practice address

2755 E Desert Inn Rd Ste 180
Las Vegas, NV 89121-3694

Phone

(702) 602-5106

NPI assigned

Apr 21, 2020

Last updated

Apr 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ibiandi Marquetti-VaronaNPI 1164051611

Title

Ceo

Phone

(702) 685-7770

Specialties & licenses 6

Addresses

Other identifiers 2

Other names 1

• CiTi MD Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ibiandi Marquetti-Varona, QBA

  • Behavior Technician
  • Las Vegas, NV
  • NPI 1164051611
  NPD Authorized official

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1508486317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2755 E DESERT INN RD STE 180",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213694",
            "telephone_number": "702-602-5106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 E DESERT INN RD STE 180",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213694",
            "telephone_number": "702-602-5106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3650 S Eastern Ave Ste 330",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891693345",
            "country_code": "US",
            "telephone_number": "725-200-1081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PACIFICA HEALTHCARE PROVIDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-21",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "MARQUETTI-VARONA",
        "authorized_official_first_name": "IBIANDI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-685-7770"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV MEDICARE",
            "identifier": "V60071",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "V60071",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CiTi MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.