Provider Demographics
NPI:1679576060
Name:PINGOL, ELLAINE SESE (MD)
Entity type:Individual
Prefix:DR
First Name:ELLAINE
Middle Name:SESE
Last Name:PINGOL
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 531465
Mailing Address - Street 2:HENDERSON
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-1465
Mailing Address - Country:US
Mailing Address - Phone:702-837-4397
Mailing Address - Fax:702-837-7426
Practice Address - Street 1:10001 S EASTERN AVE STE 210
Practice Address - Street 2:HENDERSON
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3908
Practice Address - Country:US
Practice Address - Phone:702-837-4397
Practice Address - Fax:702-837-7426
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-02-04
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Provider Licenses
StateLicense IDTaxonomies
NV10301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018781Medicaid
H69621Medicare UPIN
NV002018781Medicaid