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NPI Code Detail

MEDICARE: MERCY MEDICAL AND BEHAVIORAL INC

MEDICARE: MERCY MEDICAL AND BEHAVIORAL INC
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
1363LF0000XFamily Nurse Practitioner
2363LP0808XPsychiatric/Mental Health Nurse Practitioner
3163WW0000XWound Care Registered Nurse
4363LP2300XPrimary Care Nurse Practitioner

General Provider Information

NPI Number : 1790672491
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERCY MEDICAL AND BEHAVIORAL INC
Provider Business Mailing Address
First Line : 4055 SPENCER ST STE 216
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5251
Country : US
Telephone Number : 725-205-0288
Fax Number : 725-204-9792
Provider Business Practice Location Address
First Line : 4055 SPENCER ST STE 216
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5251
Country : US
Telephone Number : 725-205-0288
Fax Number : 725-204-9792
Authorized Official
Title or Position : PRESIDENT
Name : CECILIO P GONZALES JR.
Credential : APRN
Telephone Number : 725-205-0288
Provider Enumeration Date : 06/23/2025
Last Update Date : 05/25/2026

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Directions to “MERCY MEDICAL AND BEHAVIORAL INC ” Practice Location

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