MEDICARE: GLADYS GONGORA FRONDARINA-BELTRAN APRN

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	363LF0000X	Family Nurse Practitioner	APRN002597	NV

General Provider Information

NPI Number	:	1922526474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADYS GONGORA FRONDARINA-BELTRAN APRN

Provider Business Mailing Address
First Line	:	6270 MCLEOD DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4446
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6270 MCLEOD DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4446
Country	:	US
Telephone Number	:	702-792-5112
Fax Number	:

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

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	09/05/2017

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