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NPI Code Detail

MEDICARE: MR. MARK VICTORINO GOMEZ ARPN

MEDICARE: MR. MARK VICTORINO GOMEZ ARPN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner876911NV

General Provider Information

NPI Number : 1669220133
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK VICTORINO GOMEZ ARPN
Provider Business Mailing Address
First Line : 9013 BONANZA PEAK CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89178-9330
Country : US
Telephone Number : 702-471-8182
Fax Number :
Provider Business Practice Location Address
First Line : 2110 E FLAMINGO RD STE 309
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5193
Country : US
Telephone Number : 725-331-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2024
Last Update Date : 02/12/2026

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Directions to “ MR. MARK VICTORINO GOMEZ ARPN” Practice Location

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