Unknown Individual – Gynecology Physician, NPI 1619047008

Unknown Individual is a healthcare provider. based in Las vegas, Nevada. specializing in Gynecology Physician. They hold a License No. C35009 (CA). The NPI Number for Unknown Individual is 1619047008

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619047008
Phone
(702) 255-3547
Address
9260 W SUNSET RD
Deactivation Date
22 June 2021

Doctor Profile

Medical School Name
UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Secondary Phone
-
Graduation Year
1968 (58 years ago)
PAC ID
4981680311
Professional Enrollment ID
I20150610002650
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience33
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • West Sunset Road, Paradise, Clark County, Nevada, 89119-4016, United States

    STE. 200

    LAS VEGAS, NV 891484858

    Phone: (702) 255-3547

    Fax: (702) 921-2419

    Type: Mailing

  • 2365, Reynolds Avenue, North Las Vegas, Clark County, Nevada, 89030, United States

    NORTH LAS VEGAS, NV 890307276

    Phone: (702) 916-3537

    Fax: (702) 444-7690

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $25.

Total Amount is formed as General ($25) + Research ($0) + Ownership ($0) = $25.

Last reported payment date: 2024-06-20 • Largest payer in this snapshot: ABBVIE INC. ($25).

Total Amount

$25

General + Research + Ownership

Payments

1

Total payment records

General Amount

$25

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-06-20

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$25
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 89148)

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Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1619047008.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Gynecology Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Las Vegas, Nevada. Check all listed addresses for suites or satellite offices.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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