Healthcare Provider Details

I. General information

NPI: 1457139503
Provider Name (Legal Business Name): MARY JANE PERLOTA GAMAYAO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N GIBSON RD STE 311
HENDERSON NV
89011-1708
US

IV. Provider business mailing address

304 S JONES BLVD STE 1307
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

Practice location:
  • Phone: 702-776-8300
  • Fax: 702-776-8408
Mailing address:
  • Phone: 702-706-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number871374
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: