Active NPI
Bright Horizon Medical Center LLC
- Psychiatry Physician
- Las Vegas, NV
National Provider Identifier
1609684380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- Legal business name
- BRIGHT HORIZON MEDICAL CENTER LLC
- Practice address
- 4521 E Bonanza Rd Apt 258
Las Vegas, NV 89110-3395 - Phone
- (702) 661-6416
- NPI assigned
- Dec 26, 2024
- 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
- Odelaisy Arevalo Blanco
- Title
- Owner
- Phone
- (702) 661-6416
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | Primary | ||
| General Practice Physician | 208D00000X |
Addresses
Primary practice location
4521 E Bonanza Rd Apt 258
Las Vegas, NV 89110-3395
Mailing address
4521 E Bonanza Rd Apt 258
Las Vegas, NV 89110-3395
Phone (702) 661-6416
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735171200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1735171200000",
"number": "1609684380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4521 E BONANZA RD APT 258",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891103395",
"telephone_number": "702-661-6416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4521 E BONANZA RD APT 258",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891103395",
"telephone_number": "702-661-6416"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRIGHT HORIZON MEDICAL CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-12-26",
"last_updated": "2024-12-26",
"certification_date": "2024-12-26",
"status": "A",
"authorized_official_last_name": "AREVALO BLANCO",
"authorized_official_first_name": "ODELAISY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "702-661-6416"
},
"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 Dec 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.