Provider Demographics
NPI:1386962322
Name:GOOD CHOICE PEDIATRICS LLC
Entity type:Organization
Organization Name:GOOD CHOICE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANSLEM
Authorized Official - Middle Name:
Authorized Official - Last Name:OPARAUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-858-8773
Mailing Address - Street 1:3050 E BONANZA RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3050 E BONANZA RD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3703
Practice Address - Country:US
Practice Address - Phone:615-672-5953
Practice Address - Fax:270-751-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10268208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty