MEDICARE: MARQUIS A GASTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1083198832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUIS A GASTON

Provider Business Mailing Address
First Line	:	1049 HASSELL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2321
Country	:	US
Telephone Number	:	702-272-6355
Fax Number	:

Provider Business Practice Location Address
First Line	:	6551 MCCARRAN ST APT 3091
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1448
Country	:	US
Telephone Number	:	214-940-4240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2018

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Directions to “ MARQUIS A GASTON ” Practice Location

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