NPIMap

Individual provider Active NPI

Odessa Alelee Rarangol Pulido

  • Surgical Critical Care Physician
  • Las Vegas, NV
National Provider Identifier
1669912812
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
PENDING Issued in NV
Practice address
1707 W Charleston Blvd Ste 160
Las Vegas, NV 89102-2354
Phone
(702) 671-5150
Fax
(702) 384-6493
NPI assigned
Mar 6, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgical Critical Care Physician 2086S0102X PENDING NV Primary

Addresses

Primary practice location

1707 W Charleston Blvd Ste 160
Las Vegas, NV 89102-2354

Mailing address

3016 W Charleston Blvd Ste 100
Las Vegas, NV 89102-1973
Phone (808) 220-5499

Other practice location 1

4190 City Ave
Philadelphia, PA 19131-1626
Phone (215) 871-6690

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241218002170 NV Practitioner - General Surgery 0244767085 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Philadelphia College of Osteopathic Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unlv MedicineGroup PAC ID 4183991458, 177 clinicians

Practice addresses (Care Compare)

1707 W Charleston Blvd
Suite 160
Las Vegas, NV 89102-2354
Phone (702) 671-5150

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Unlv Medicine CurrentSince Nov 20, 2024 Accepting new patients
Unlv Medicine CurrentSince Nov 20, 2024 Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients

Locations

2724 N Tenaya Way
Fl 2
Las Vegas, NV 89128
Phone (702) 939-8557

3016 W Charleston Blvd
Ste 100
Las Vegas, NV 89102
Phone (702) 780-2315

1707 W Charleston Blvd
Ste 110
Las Vegas, NV 89102
Phone (702) 671-2300

1707 W Charleston Blvd
Ste 160
Las Vegas, NV 89102
Phone (702) 671-2201

Organizations & group practices 3

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1669912812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 W CHARLESTON BLVD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021973",
            "telephone_number": "808-220-5499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 W CHARLESTON BLVD STE 160",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022354",
            "telephone_number": "702-671-5150",
            "fax_number": "702-384-6493"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4190 City Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191311626",
            "country_code": "US",
            "telephone_number": "215-871-6690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PULIDO",
        "first_name": "ODESSA ALELEE",
        "middle_name": "RARANGOL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-06",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "NV",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.