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NPI Code Detail

MEDICARE: THOMAS GENNARO II

MEDICARE: THOMAS GENNARO II
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1922303239
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS GENNARO II
Provider Business Mailing Address
First Line : 1024 MOCHA MATTARI ST
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5012
Country : US
Telephone Number : 702-523-3068
Fax Number :
Provider Business Practice Location Address
First Line : 3435 W CRAIG RD STE A
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-5116
Country : US
Telephone Number : 702-750-0377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2011
Last Update Date : 01/18/2011

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Directions to “ THOMAS GENNARO II ” Practice Location

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