Individual provider Active NPI

Mitzilene Anne Alfonso Tuazon, MD

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1528402351
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16533 Issued in NV
Practice address
4475 S Eastern Ave
Las Vegas, NV 89119-7826
Phone
(702) 737-1880
Fax
(702) 650-2458
NPI assigned
Apr 23, 2013
Last updated
Nov 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 157598 FL
Family Medicine Physician 207Q00000X 16533 NV Primary
Adult Medicine Physician 207QA0505X 157598 FL

Addresses

Primary practice location

4475 S Eastern Ave
Las Vegas, NV 89119-7826

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 877-5199

Other practice location 1

1430 SW Saint Lucie West Blvd Ste 101
Port St Lucie, FL 34986-2134
Phone (772) 877-3591

Other identifiers 1

IdentifierTypeStateIssuer
SMA MEDICAREOtherNVV114219

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160816002929 NV Practitioner - Family Practice 3779701198 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Medical Group II Rhodes P CGroup PAC ID 4981687779, 296 clinicians

Practice addresses (Care Compare)

4475 S Eastern Ave
Las Vegas, NV 89119-7826
Phone (702) 579-3253

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
157598FLMDFamily Medicine Physician
16533NVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, Inc CurrentSince Aug 22, 2016 Accepting new patients
Optum Medical Group Rhodes P C CurrentSince Jun 2, 2019 Accepting new patients
Optum Medical Group II Rhodes P C CurrentSince Jun 2, 2019 Accepting new patients
Henderson Hospital Past Accepting new patients
Desert View Regional Medical Center Holdings, LLC Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
Spring Valley Medical Center Past Accepting new patients
Dignity Health Past Accepting new patients
Southern Hills Medical Center, LLC Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients
Baptist Health Madisonville Inc Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
Dignity Health Past Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients
Spring Valley Medical Center Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients
North Vista Hospital LLC Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients
Dignity Health Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients

Locations

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710

4475 S Eastern Ave
Las Vegas, NV 89119
Phone (702) 669-5811

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1566/brand/2/csg/41/fhir/r4
  • Direct secure messaging: mtuazon119422@westdirect.optum.com

Organizations & group practices 23

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1366675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1528402351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-877-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4475 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891197826",
            "telephone_number": "702-737-1880",
            "fax_number": "702-650-2458"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 SW Saint Lucie West Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Port St Lucie",
            "state": "FL",
            "postal_code": "349862134",
            "country_code": "US",
            "telephone_number": "772-877-3591",
            "fax_number": "561-623-0613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUAZON",
        "first_name": "MITZILENE",
        "middle_name": "ANNE ALFONSO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-23",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "157598",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "16533",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "FL",
            "license": "157598",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "V114219",
            "identifier": "SMA MEDICARE",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.