Provider Demographics
NPI:1235565201
Name:NGATA, RAYMOND BLAISE
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:BLAISE
Last Name:NGATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 FREEPORT BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6259
Mailing Address - Country:US
Mailing Address - Phone:775-358-8290
Mailing Address - Fax:775-358-0612
Practice Address - Street 1:390 FREEPORT BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6259
Practice Address - Country:US
Practice Address - Phone:775-358-8290
Practice Address - Fax:775-358-0612
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion