MEDICARE: GOLDA IVASHKOV HOGAN B.S.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	07730-I	NV

General Provider Information

NPI Number	:	1952769192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GOLDA IVASHKOV HOGAN B.S.

Provider Business Mailing Address
First Line	:	40 N FOGG ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5143
Country	:	US
Telephone Number	:	702-408-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	6048 S DURANGO DR STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1781
Country	:	US
Telephone Number	:	702-815-1550
Fax Number	:

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

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	04/12/2024

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