MEDICARE: ANTHONY MICHAEL GAGNI

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	251S00000X	Community/Behavioral Health Agency
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1659845113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY MICHAEL GAGNI

Provider Business Mailing Address
First Line	:	76 MANDALA PEAK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-5509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 MANDALA PEAK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-5509
Country	:	US
Telephone Number	:	702-978-3977
Fax Number	:

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

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	11/29/2020

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