Healthcare Provider Details

I. General information

NPI: 1083295406
Provider Name (Legal Business Name): GEMMA VIRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 E SAHARA AVE STE C
LAS VEGAS NV
89104-3022
US

IV. Provider business mailing address

4850 W FLAMINGO RD STE 25
LAS VEGAS NV
89103-3707
US

V. Phone/Fax

Practice location:
  • Phone: 702-871-9917
  • Fax:
Mailing address:
  • Phone: 702-871-9917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF03210566
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: