MR. RUSTIN JIN PARK (NPI# 1003112814) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003112814 |
| Entity Type | Individual |
| Full Name | MR. RUSTIN JIN PARK |
| Credential | RN, BSN |
| Practice Address |
4000 E Charleston Blvd Suite 130 Las Vegas NV 89104-6659 |
| Practice Telephone | 7029684020 |
| Practice Fax Number | 7029684040 |
| Mailing Telephone | 7029684020 |
| Mailing Fax Number | 7029684040 |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2011-01-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
RN65754 | NV | Nursing Service Providers |
| Street Address |
4000 E CHARLESTON BLVD SUITE 130 |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89104-6659 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083683874 | Nevada Family Practice Residence Program | Pharmacy | 4000 E Charleston Blvd, B-130, Las Vegas, NV 89104-6659 | 2006-03-15 |
| 1598207847 | Delores Glenn-lewis | Counselor | 4000 E Charleston Blvd, 226, Las Vegas, NV 89104-6659 | 2016-11-17 |
| 1447602974 | Dori Hilson | Social Worker | 4000 E Charleston Blvd, Las Vegas, NV 89104-6659 | 2016-07-08 |
| 1386096766 | Alexis Harris | Community Health Worker | 4000 E Charleston Blvd, Ste. 230, Las Vegas, NV 89104-6659 | 2016-07-08 |
| 1770930133 | Erin Maria Spanberger | Counselor | 4000 E Charleston Blvd, Suite #230, Las Vegas, NV 89104-6659 | 2016-05-16 |
| 1447619267 | Brandi Mcconnell | Social Worker | 4000 E Charleston Blvd, Suite 230, Las Vegas, NV 89104-6659 | 2016-02-22 |
| 1548639271 | Desirae Chantal Murenzi | Registered Nurse | 4000 E Charleston Blvd, Sutie 230, Las Vegas, NV 89104-6659 | 2015-09-23 |
| 1518335801 | Angela Acuna | Registered Nurse | 4000 E Charleston Blvd, Suite 230, Las Vegas, NV 89104-6659 | 2015-09-03 |
| 1053795898 | Natalie Rose Schmaltz | Social Worker | 4000 E Charleston Blvd, 230, Las Vegas, NV 89104-6659 | 2015-07-10 |
| 1124456033 | Winnie Wegner | Registered Nurse | 4000 E Charleston Blvd, Ste #130, Las Vegas, NV 89104-6659 | 2013-10-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316550635 | Comfort Care Senior Services LLC | In Home Supportive Care | 1601 S Sandhill Rd, 62, Las Vegas, NV 89104 | 2020-08-26 |
| 1508484734 | Accessible Space Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1405 South Mojave Rd, Las Vegas, NV 89104 | 2020-07-14 |
| 1003448333 | Shirley Lauren Valenzona-gianan | Pharmacist | Smith's Pharmacy #318, 4965 East Sahara Avenue, Las Vegas, NV 89104 | 2020-02-05 |
| 1427602713 | Alma Lucia Lozano-vargas | Chore Provider | 1785 E. Sahara Ave. Suite 485, Las Vegas, NV 89104 | 2019-07-25 |
| 1396398947 | Martinez Antuan Coates | Psychologist | 1755 Palm St Bld T Apt147, Las Vegas, NV 89104 | 2019-07-23 |
| 1982171518 | Ian Sande | Occupational Therapist | 1500 West Warm Springs Rd, Las Vegas, NV 89104 | 2018-11-01 |
| 1215436563 | A Better Life In Home Care, LLC | Technician | 1810 East Sahara Avenue, Suite 216, Las Vegas, NV 89104 | 2018-02-01 |
| 1891202016 | Nevada Helping Hands LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1810 E Sahara Ave Ste 143, Las Vegas, NV 89104 | 2018-01-09 |
| 1760901581 | Fannie Bell | Counselor | 1800 E. Sahara Suite 104, Las Vegas, NV 89104 | 2017-09-13 |
| 1386162147 | Jaclyn Mustachio | Social Worker | 1860 E Sahara Ave, Las Vegas, NV 89104 | 2017-08-31 |
| Find all providers in zip 89104 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831602325 | Edina Boros | Registered Nurse | 4370 S Grand Canyon Dr Apt 1100, Las Vegas, NV 89147-7114 | 2017-11-07 |
| 1235668518 | Merle Ambray Go | Registered Nurse | 1055 E Flamingo Rd, Apt 224, Las Vegas, NV 89119 | 2017-06-08 |
| 1023544301 | Kellie Marsh | Registered Nurse | 7604 Cruz Bay Ct, Las Vegas, NV 89128-7282 | 2017-05-05 |
| 1730615097 | Erica Zara | Registered Nurse | 2555 Red Springs Dr, Las Vegas, NV 89135-1512 | 2017-05-05 |
| 1972036663 | Ashley Murray | Registered Nurse | 2700 S Las Vegas Blvd #1506, Las Vegas, NV 89109 | 2017-04-10 |
| 1750767695 | Linda Busell | Registered Nurse | 2508 Living Rock St, Las Vegas, NV 89106-1464 | 2015-08-03 |
| 1366831224 | Arthur Kime | Registered Nurse | 3940 Copper Glen St, Las Vegas, NV 89129-7875 | 2015-01-15 |
| 1225335888 | R.u.s.h. Organization | Registered Nurse | 6212 Camino De Rosa, Las Vegas, NV 89108 | 2011-02-17 |
| 1801062567 | Frances Boddie-small | Registered Nurse | 1785 E Sahara Ave Ste 145, Las Vegas, NV 89104-3713 | 2008-05-02 |
| 1033220355 | Marcia Hyatt Evans | Registered Nurse | 912 W Owens Ave, Las Vegas, NV 89106-2516 | 2006-08-31 |
| Find all providers in LAS VEGAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.