Healthcare Provider Details

I. General information

NPI: 1851221212
Provider Name (Legal Business Name): JEROME CHRISTIAN MOSTAZA SANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 N FORT APACHE RD
LAS VEGAS NV
89149-2300
US

IV. Provider business mailing address

386 UMBRIA WAY
HENDERSON NV
89014-5151
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-3000
  • Fax:
Mailing address:
  • Phone: 702-417-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-1724
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: