MEDICARE: VICENTE HECTOR GATAN APRN

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	364S00000X	Clinical Nurse Specialist	APN001024	NV
2	363L00000X	Nurse Practitioner	APN001024	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CQ729X	OTHER	NV	MEDICARE - SMA CONVENIENT CARE

Other Identifiers

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

General Provider Information

NPI Number	:	1477722866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICENTE HECTOR GATAN APRN

Provider Business Mailing Address
First Line	:	PO BOX 15645
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5645
Country	:	US
Telephone Number	:	702-243-8500
Fax Number	:	702-363-8753

Provider Business Practice Location Address
First Line	:	6276 S RAINBOW BLVD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3243
Country	:	US
Telephone Number	:	702-396-4165
Fax Number	:	702-252-4405

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

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	03/04/2019

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Directions to “ VICENTE HECTOR GATAN APRN” Practice Location

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