Healthcare Provider Details

I. General information

NPI: 1265771489
Provider Name (Legal Business Name): GINA AMAYA DO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9957 BISCAYNE LN
LAS VEGAS NV
89117-3625
US

IV. Provider business mailing address

9957 BISCAYNE LN
LAS VEGAS NV
89117-3625
US

V. Phone/Fax

Practice location:
  • Phone: 908-653-9399
  • Fax:
Mailing address:
  • Phone: 908-653-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GINA AMAYA
Title or Position: OWNER
Credential: DO
Phone: 908-653-9399