MEDICARE: DR. ANITA GONDY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	7945	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	880400613	OTHER	NV	OB-GYN

General Provider Information

NPI Number	:	1417940032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA GONDY M.D.

Provider Business Mailing Address
First Line	:	2011 PINTO LN STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4005
Country	:	US
Telephone Number	:	702-978-7617
Fax Number	:	702-912-4994

Provider Business Practice Location Address
First Line	:	2800 N TENAYA WAY STE 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1100
Country	:	US
Telephone Number	:	702-978-8900
Fax Number	:	702-978-7617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	12/01/2022

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Directions to “ DR. ANITA GONDY M.D.” Practice Location

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