Healthcare Provider Details

I. General information

NPI: 1053771550
Provider Name (Legal Business Name): RAYMOND GREGORIO TIMBOL CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
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
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: