MEDICARE: GEMMA CABULONG

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1588060602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEMMA CABULONG

Provider Business Mailing Address
First Line	:	3742 KELTIE BROOK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3233
Country	:	US
Telephone Number	:	702-821-5863
Fax Number	:	702-684-7788

Provider Business Practice Location Address
First Line	:	3742 KELTIE BROOK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3233
Country	:	US
Telephone Number	:	702-821-5863
Fax Number	:	702-684-7788

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

Provider Enumeration Date	:	11/17/2014
Last Update Date	:	11/17/2014

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Directions to “ GEMMA CABULONG ” Practice Location

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