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General NPI Number Information
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NPI Number | 1205343761
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Entity Type | Organization
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Legal Business Name | HILDA GOMEZ
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 3355 SPRING MOUNTAIN RD STE 67
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City | LAS VEGAS
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State | NV
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Zip | 89102
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Country | US
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Telephone | 702-358-2508
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Fax |
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Provider Business Mailing Address
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Address Line | 3355 SPRING MOUNTAIN RD STE 67
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City | LAS VEGAS
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State | NV
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Zip | 89102-8633
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Country | US
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Telephone | 702-358-2508
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | HILDA GOMEZ
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Credential |
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Telephone | 702-358-2508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 8808-PCS-0
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License Number State |
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