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Mark Gordon Vallejo Salvador

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

6352 Medical Center St, Las Vegas, NV 89148-2413

PECOS Enrollment

This provider is enrolled in PECOS as MARK SALVADOR.

Based on the most recent information from CMS, provider Mark Gordon Vallejo Salvador is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1841667417
Provider Type
Individual
Full Name
Salvador, Mark Gordon Vallejo
Credential
APRN, NP-C

Gender
Male
Sole Proprietor
Yes
Enumeration Date
8/30/2015
Last Updated
4/11/2016

Contact Information

Practice Location

6352 Medical Center St, Las Vegas, NV 89148-2413

(702) 541-6200

Unlisted Fax

Mailing Location

10624 S Eastern Ave, Apt 3-205, Henderson, NV 89052-2982

(702) 407-7700

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License APRN002017 Nevada

Mark Gordon Vallejo Salvador

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Chin, Gisela

Sahagun, Nancy

Iwobi, Christian

Dinehart, Kayoko

Yun, Kikam

Tong, Ngoc Loan

Adlerstein, Robert T

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Belete, Judith Aquino