Provider Demographics
NPI:1851766117
Name:HOMER C TUAZON LLC
Entity type:Organization
Organization Name:HOMER C TUAZON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUAZON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, PMHNP-C
Authorized Official - Phone:702-417-3865
Mailing Address - Street 1:3130 S RAINBOW BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6212
Mailing Address - Country:US
Mailing Address - Phone:702-444-7744
Mailing Address - Fax:702-444-7898
Practice Address - Street 1:3130 S RAINBOW BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6212
Practice Address - Country:US
Practice Address - Phone:702-444-7744
Practice Address - Fax:702-444-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 363LP0808X, 363LP0808X
NVAPRN001431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty