Healthcare Provider Details

I. General information

NPI: 1033497151
Provider Name (Legal Business Name): LATONYA REASHAWN GASTON CPC-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 COUNTRY GROVE AVE
NORTH LAS VEGAS NV
89030-4707
US

IV. Provider business mailing address

1001 COUNTRY GROVE AVE
NORTH LAS VEGAS NV
89030-4707
US

V. Phone/Fax

Practice location:
  • Phone: 702-439-9358
  • Fax:
Mailing address:
  • Phone: 702-439-9358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI0133
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: