Healthcare Provider Details

I. General information

NPI: 1346719929
Provider Name (Legal Business Name): IGNACIO GACUTAN MONTORIO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8290 W SAHARA AVE STE 260
LAS VEGAS NV
89117-8933
US

IV. Provider business mailing address

8290 W SAHARA AVE STE 260
LAS VEGAS NV
89117-8933
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-9949
  • Fax:
Mailing address:
  • Phone: 702-262-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: