Basic Information
| Provider Information | |||||||||
| NPI: | 1235105313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ONTANILLAS | ||||||||
| FirstName: | MAJONEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15645 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891145645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022438500 | ||||||||
| FaxNumber: | 7022424194 | ||||||||
| Practice Location | |||||||||
| Address1: | 2704 N TENAYA WAY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022438500 | ||||||||
| FaxNumber: | 7022424194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 01/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 223130 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 12413 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1235105313 | 05 | NV | MEDICAID | J28398 | 01 | BLUE SHIELD INDEMNITY | OTHER | AA22681 | 01 | HARVARD PILGRIM | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 419302 | 01 | TUFTS HEALTH PLAN | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | A38033 | 01 | MEDICARE B | OTHER | 042472266 | 01 | UNITED HEALTHCARE | OTHER | 1919739 | 01 | FIRST HEALTH | OTHER | 7398225 | 01 | AETNA US HEALTHCARE | OTHER | J28398 | 01 | BLUE SHIELD HMO BLUE | OTHER | 2091283 | 01 | MEDICAID WELFARE | OTHER | 2091283 | 05 | MA | MEDICAID | 784170 | 01 | MVP HEALTH CARE | OTHER | 91262 | 01 | FALLON COMMUNITY HEALTH | OTHER | J28398 | 01 | BLUE CARE ELECT | OTHER | 4714498 | 01 | CIGNA HEALTH PLAN | OTHER |