Healthcare Provider Details

I. General information

NPI: 1306184130
Provider Name (Legal Business Name): GS OUTPATIENT FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 W HORIZON RIDGE PKWY. SUITE 101
HENDERSON NV
89052
US

IV. Provider business mailing address

PO BOX 777851
HENDERSON NV
89077-7851
US

V. Phone/Fax

Practice location:
  • Phone: 702-839-0091
  • Fax: 702-839-0095
Mailing address:
  • Phone: 702-893-3333
  • Fax: 702-893-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License NumberNV20111684903
License Number StateNV

VIII. Authorized Official

Name: MR. RAUL ABEJUELA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 702-893-3333