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General NPI Number Information
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NPI Number | 1275029092
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Entity Type | Individual
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Provider Name | MAVIES FERMIN GASCON LMY, MMP
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Gender | Male
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Dates
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Enumeration Date | 07/04/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 7455 W WASHINGTON AVE STE 210
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City | LAS VEGAS
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State | NV
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Zip | 89128-4338
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Country | US
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Telephone | 702-489-6640
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Fax |
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Provider Business Mailing Address
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Address Line | 217 W CHICAGO AVE APT D
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City | LAS VEGAS
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State | NV
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Zip | 89102-2825
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Country | US
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Telephone | 702-917-5098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | NVMT.6495
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License Number State | NV
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