Healthcare Provider Details

I. General information

NPI: 1174037709
Provider Name (Legal Business Name): HEATHER GAMEZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SAINT ROSE PKWY
HENDERSON NV
89052-3839
US

IV. Provider business mailing address

2654 W HORIZON RIDGE PKWY
HENDERSON NV
89052-2803
US

V. Phone/Fax

Practice location:
  • Phone: 702-616-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number171138
License Number StateNV

VIII. Authorized Official

Name: MS. HEATHER GAMEZ
Title or Position: CERTIFIED SURGICAL FIRST ASSISTANT
Credential: CSFA
Phone: 702-574-2114