NPIMap

Individual provider Active NPI

Jacqueline L. Perez-Tselikis, M.D.

  • Pediatrics Physician
  • Las Vegas, NV
National Provider Identifier
1720015795
Registry record updated Feb 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
7004 Issued in NV
Practice address
10105 Banburry Cross Dr
Suite 370
Las Vegas, NV 89144-6646
Phone
(702) 260-4525
Fax
(702) 869-0133
NPI assigned
Jun 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 7004 NV Primary

Addresses

Primary practice location

10105 Banburry Cross Dr
Suite 370
Las Vegas, NV 89144-6646

Mailing address

10105 Banburry Cross Dr
Suite 370
Las Vegas, NV 89144-6646
Phone (702) 260-4525

Other identifiers 1

IdentifierTypeStateIssuer
002019680MedicaidNV

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
7004NVMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Valley Pediatrics, LLP Pediatrics Past Accepting new patients
Southern Hills Medical Center, LLC Past Accepting new patients
Dignity Health Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423526400000",
    "number": "1720015795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10105 BANBURRY CROSS DR",
            "address_2": "SUITE 370",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891446646",
            "telephone_number": "702-260-4525",
            "fax_number": "702-869-0133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10105 BANBURRY CROSS DR",
            "address_2": "SUITE 370",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891446646",
            "telephone_number": "702-260-4525",
            "fax_number": "702-869-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ-TSELIKIS",
        "first_name": "JACQUELINE",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2015-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "7004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002019680",
            "state": "NV"
        }
    ],
    "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 Feb 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.