Healthcare Provider Details

I. General information

NPI: 1922478890
Provider Name (Legal Business Name): GABRIEL BAYI EKORTARH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2015
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 W CHARLESTON BLVD STE 203
LAS VEGAS NV
89102-1858
US

IV. Provider business mailing address

310 W OAKLAWN RD
PLEASANTON TX
78064-4033
US

V. Phone/Fax

Practice location:
  • Phone: 702-848-4443
  • Fax: 702-805-0299
Mailing address:
  • Phone: 830-569-8940
  • Fax: 830-569-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129360
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP129360
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number815341
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: