Healthcare Provider Details

I. General information

NPI: 1174455737
Provider Name (Legal Business Name): ANGEL GOMEZ-VENZOR CPC-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 W CHARLESTON BLVD
LAS VEGAS NV
89102-1829
US

IV. Provider business mailing address

614 GLENWOOD LN
HENDERSON NV
89002-8403
US

V. Phone/Fax

Practice location:
  • Phone: 702-548-0157
  • Fax:
Mailing address:
  • Phone: 702-712-6990
  • Fax: 702-712-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCI5721
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: