Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 17945 | NV |
NPI | 1316380959 |
---|---|
Provider Name | Gustavo Osei Garcia |
First Address | Las Vegas, NV 89121-3609 |
Second Address | Las Vegas, NV 89121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2013 |
Last Update Date | 16/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17945 | NV MEDICAL LICENSE (01) | NV |