Healthcare Provider Details

I. General information

NPI: 1477722866
Provider Name (Legal Business Name): VICENTE HECTOR GATAN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-3243
US

IV. Provider business mailing address

PO BOX 15645
LAS VEGAS NV
89114-5645
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-4165
  • Fax: 702-252-4405
Mailing address:
  • Phone: 702-243-8500
  • Fax: 702-363-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPN001024
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN001024
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: