MEDICARE: MS. ANGEL COLLEEN GONZALEZ RECRATIONAL THERAPY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	175T00000X	Peer Specialist
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1124747597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGEL COLLEEN GONZALEZ RECRATIONAL THERAPY

Provider Business Mailing Address
First Line	:	7345 S DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3653
Country	:	US
Telephone Number	:	253-365-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2595 S JONES BLVD
Second Line	:	SUITE 2F
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0000
Country	:	US
Telephone Number	:	702-806-9143
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	08/26/2022

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