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NPI Code Detail

MEDICARE: ANGELINA GARCILAZO GOMEZ

MEDICARE: ANGELINA GARCILAZO GOMEZ
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
1253Z00000XIn Home Supportive Care Agency03155618NV

General Provider Information

NPI Number : 1821591165
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELINA GARCILAZO GOMEZ
Provider Business Mailing Address
First Line : 4715 SAN LEANDRO AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-1751
Country : US
Telephone Number : 702-272-7099
Fax Number :
Provider Business Practice Location Address
First Line : 3101 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1931
Country : US
Telephone Number : 702-839-2060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2018
Last Update Date : 03/13/2018

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Directions to “ ANGELINA GARCILAZO GOMEZ ” Practice Location

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