Basic Information
| Provider Information | |||||||||
| NPI: | 1851766117 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOMER C TUAZON LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | APOLLO MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 400546 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891400546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024447744 | ||||||||
| FaxNumber: | 7024447898 | ||||||||
| Practice Location | |||||||||
| Address1: | 6330 W FLAMINGO RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891032234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024447744 | ||||||||
| FaxNumber: | 7024447898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2015 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | TUAZON | ||||||||
| AuthorizedOfficialFirstName: | HOMER | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7024173865 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN, FNPC | ||||||||
| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 8770 | NV | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 2471C3402X | 8770 | NV | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LF0000X | APRN001431 | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.