Provider Demographics
| NPI: | 1548629132 |
|---|---|
| Name: | FIRST PERSON CARE CLINIC |
| Entity type: | Organization |
| Organization Name: | FIRST PERSON CARE CLINIC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ROXANA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | VALETON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 702-380-8118 |
| Mailing Address - Street 1: | 1200 S 4TH ST |
| Mailing Address - Street 2: | SUITE 111 |
| Mailing Address - City: | LAS VEGAS |
| Mailing Address - State: | NV |
| Mailing Address - Zip Code: | 89104-1063 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 702-380-8118 |
| Mailing Address - Fax: | 702-380-2929 |
| Practice Address - Street 1: | 1200 S 4TH ST |
| Practice Address - Street 2: | SUITE 111 |
| Practice Address - City: | LAS VEGAS |
| Practice Address - State: | NV |
| Practice Address - Zip Code: | 89104-1063 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 702-380-8118 |
| Practice Address - Fax: | 702-380-2929 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2016-02-11 |
| Last Update Date: | 2025-01-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 1223G0001X, 207Q00000X, 207RC0000X, 207RI0200X, 207RR0500X, 207V00000X, 208000000X, 261QF0050X, 261QI0500X, 261QM0801X, 363A00000X, 363LF0000X, 363LG0600X, 363LX0001X | ||
| NV | 261QF0400X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | Group - Multi-Specialty |
| No | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 261QF0050X | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | |
| No | 261QI0500X | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | Group - Multi-Specialty |
| No | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NV | 1659612547 | Medicaid | |
| NV | HD186A | Medicare UPIN |
