Healthcare Provider Details

I. General information

NPI: 1477633584
Provider Name (Legal Business Name): IRENE GOYA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CHARLESTON BLVD SUITE B230
LAS VEGAS NV
89104-6659
US

IV. Provider business mailing address

4000 E CHARLESTON BLVD SUITE 130
LAS VEGAS NV
89104-6659
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-4000
  • Fax: 702-968-4040
Mailing address:
  • Phone: 702-968-4000
  • Fax: 702-968-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN52641
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN 001775
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: