Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003190554 |
---|---|
Provider Name | Edwin Nuneza Garcia JR. |
First Address | Pahrump, NV 89048-6515 |
Second Address | Pahrump, NV 89048-6515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2011 |
Last Update Date | 03/10/2011 |