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NPI Code Detail

MEDICARE: JUAN CARLOS GONZALEZ SR. NP

MEDICARE: JUAN CARLOS GONZALEZ SR. NP
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
1363LA2200XAdult Health Nurse Practitioner823386NV
2363LF0000XFamily Nurse Practitioner823386NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205215027
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN CARLOS GONZALEZ SR. NP
Provider Business Mailing Address
First Line : 6859 S EASTERN AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0003
Country : US
Telephone Number : 702-601-3771
Fax Number :
Provider Business Practice Location Address
First Line : 6859 S EASTERN AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0003
Country : US
Telephone Number : 702-601-3771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2015
Last Update Date : 03/26/2025

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