Provider Demographics
NPI:1619110350
Name:PROSSAVID HEALTH CARE CENTER L C
Entity type:Organization
Organization Name:PROSSAVID HEALTH CARE CENTER L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO MILANES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:702-488-0544
Mailing Address - Street 1:3365 E FLAMINGO RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7440
Mailing Address - Country:US
Mailing Address - Phone:702-764-7765
Mailing Address - Fax:702-552-5160
Practice Address - Street 1:3365 E FLAMINGO RD STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7440
Practice Address - Country:US
Practice Address - Phone:702-764-7765
Practice Address - Fax:702-552-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1619110350Medicaid
NVBQ993AMedicare PIN
NV1619110350Medicaid