Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 2108 | NV |
NPI | 1013483189 |
---|---|
Provider Name | Antonio Gonzalez-Anaya JR. |
First Address | North Las Vegas, NV 89084-2333 |
Second Address | Las Vegas, NV 89113-1781 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2018 |
Last Update Date | 16/10/2018 |