Healthcare Provider Details

I. General information

NPI: 1598188146
Provider Name (Legal Business Name): MRS. NORMA GOMEZ I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 OLVERA WAY
LAS VEGAS NV
89128-0568
US

IV. Provider business mailing address

1201 OLVERA WAY
LAS VEGAS NV
89128-0568
US

V. Phone/Fax

Practice location:
  • Phone: 702-502-4633
  • Fax: 702-982-3069
Mailing address:
  • Phone: 702-502-4633
  • Fax: 702-982-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: