MEDICARE: REINA BAUTA GOMEZ MEDICAL MASSAGE LMT

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	225700000X	Massage Therapist	NVMT.8237	NV

General Provider Information

NPI Number	:	1871312553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REINA BAUTA GOMEZ MEDICAL MASSAGE LMT

Provider Business Mailing Address
First Line	:	133 W LAKE MEAD PKWY STE 140
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-7071
Country	:	US
Telephone Number	:	702-640-7158
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 W LAKE MEAD PKWY STE 140
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-7071
Country	:	US
Telephone Number	:	702-640-7158
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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