Healthcare Provider Details

I. General information

NPI: 1740986231
Provider Name (Legal Business Name): JOSE F GONZALEZ-ARMENTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 S LAMB BLVD TRLR 47
LAS VEGAS NV
89121-1831
US

IV. Provider business mailing address

2627 S LAMB BLVD TRLR 47
LAS VEGAS NV
89121-1831
US

V. Phone/Fax

Practice location:
  • Phone: 702-200-6199
  • Fax: 702-485-4837
Mailing address:
  • Phone: 702-200-6199
  • Fax: 702-485-4837

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: