Healthcare Provider Details

I. General information

NPI: 1740986579
Provider Name (Legal Business Name): RUTHANN DUENAS GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

850 MILL ST STE 100
RENO NV
89502-1463
US

IV. Provider business mailing address

850 MILL ST STE 100
RENO NV
89502-1463
US

V. Phone/Fax

Practice location:
  • Phone: 775-538-6700
  • Fax: 775-688-5878
Mailing address:
  • Phone: 775-538-6700
  • Fax: 775-688-5878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: