MEDICARE: ELSA GOMEZ DE CASTRO

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	225400000X	Rehabilitation Practitioner

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	:	1578995916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSA GOMEZ DE CASTRO

Provider Business Mailing Address
First Line	:	2605 RAINBOW GLOW ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3709
Country	:	US
Telephone Number	:	702-630-5009
Fax Number	:	702-631-9821

Provider Business Practice Location Address
First Line	:	2605 RAINBOW GLOW ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3709
Country	:	US
Telephone Number	:	702-630-5009
Fax Number	:	702-631-9821

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

Provider Enumeration Date	:	08/08/2013
Last Update Date	:	08/08/2013

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Directions to “ ELSA GOMEZ DE CASTRO ” Practice Location

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