NPIMap

Maria Desquitado-Tabora, MD

Individual provider Active NPI Pediatrics Physician · Las Vegas, NV

NPI 1508949462 · NPPES record last updated Jun 8, 2023

Key facts

NPI
1508949462
Entity type
Individual (NPI type 1)
Primary specialty
Pediatrics Physician 208000000X
License
NV9693 (NV)
Practice address
3301 W Charleston Blvd
Las Vegas, NV 89102-1835
Phone
(702) 968-0100
Fax
(702) 968-0104
NPI assigned
Oct 23, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 2

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
NV9693NVMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Nevada Medical & Pediatrics Associates LLC Current Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients

Locations

3301 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 900-5616

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NV9693 NV Yes

Addresses

Primary practice location

3301 W Charleston Blvd
Las Vegas, NV 89102-1835

Mailing address

3301 W Charleston Blvd
Las Vegas, NV 89102-1835
Phone (702) 968-0100

Other identifiers

IdentifierTypeStateIssuer
002018766MedicaidNV

Other providers in Las Vegas, NV

All providers in Las Vegas, NV · Pediatrics Physician in Nevada

Sources for this page

Verify at the official NPI Registry.