Healthcare Provider Details

I. General information

NPI: 1255904116
Provider Name (Legal Business Name): LAUREN GONZALEZ, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 S RAINBOW BLVD STE 100-717
LAS VEGAS NV
89139-6483
US

IV. Provider business mailing address

8020 S RAINBOW BLVD STE 100-717
LAS VEGAS NV
89139-6483
US

V. Phone/Fax

Practice location:
  • Phone: 725-910-1404
  • Fax:
Mailing address:
  • Phone: 725-910-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN GONZALEZ
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 304-690-5546