NPIMap

Organization Active NPI

Doyne Medical Clinic Inc

Doing business as Doyne Medical Clinic

  • Primary Care Nurse Practitioner
  • Las Vegas, NV
National Provider Identifier
1710997291
Registry record updated Sep 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
DOYNE MEDICAL CLINIC INC
Doing business as
Doyne Medical Clinic
Practice address
1706 W Bonanza Rd
Las Vegas, NV 89106-4704
Phone
(702) 631-6860
Fax
(702) 631-6864
NPI assigned
Aug 8, 2006
Reactivated
Aug 24, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2026

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

Authorized official

Name
Mario Oliver Tablante Godoy, CNPNPI 1275822611
Title
Medical Director
Phone
(702) 631-6860

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

1706 W Bonanza Rd
Las Vegas, NV 89106-4704

Mailing address

1706 W Bonanza Rd
Las Vegas, NV 89106-4704
Phone (702) 631-6860

Other identifiers 1

IdentifierTypeStateIssuer
100512557MedicaidNV

Other names 1

  • Doyne Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100331000288 NV Part B Supplier - Clinic/Group Practice 1951380955 Receives reassigned benefits from 10 practitioners
Practice locations: Las Vegas, NV

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D0889673Doyne Medical Clinic1706 W Bonanza Rd, Las Vegas, NV 89106Certificate of waiverJan 29, 2027

National Provider Directory

National Provider Directory

Locations

1706 W Bonanza Rd
Las Vegas, NV 89106
Phone (702) 631-6860

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788912000000",
    "number": "1710997291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 W BONANZA RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064704",
            "telephone_number": "702-631-6860",
            "fax_number": "702-631-6864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 W BONANZA RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064704",
            "telephone_number": "702-631-6860",
            "fax_number": "702-631-6864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOYNE MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "deactivation_date": "2026-08-15",
        "reactivation_date": "2026-08-24",
        "status": "A",
        "authorized_official_last_name": "GODOY",
        "authorized_official_first_name": "MARIO OLIVER",
        "authorized_official_middle_name": "TABLANTE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "702-631-6860",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100512557",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doyne Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.