Healthcare Provider Details

I. General information

NPI: 1932681699
Provider Name (Legal Business Name): GELELA FIKRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S JONES BLVD
LAS VEGAS NV
89107-2658
US

IV. Provider business mailing address

924 CAREY GROVE AVE
NORTH LAS VEGAS NV
89030-4708
US

V. Phone/Fax

Practice location:
  • Phone: 702-502-8021
  • Fax:
Mailing address:
  • Phone: 702-885-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: