Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1336727106 |
---|---|
Provider Name | Ashly Gomez |
First Address | Las Vegas, NV 89110-4655 |
Second Address | Las Vegas, NV 89122-6039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2021 |
Last Update Date | 31/03/2021 |