MEDICARE: RAMON GONZALES BAYUGA 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
1	363LF0000X	Family Nurse Practitioner	812957	NV

General Provider Information

NPI Number	:	1821568528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMON GONZALES BAYUGA NP

Provider Business Mailing Address
First Line	:	5567 JELSMA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-8683
Country	:	US
Telephone Number	:	909-576-3658
Fax Number	:

Provider Business Practice Location Address
First Line	:	6859 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0002
Country	:	US
Telephone Number	:	702-888-1037
Fax Number	:

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

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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