Provider Demographics
NPI:1275996662
Name:GAMO, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GAMO
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 1:5258 S EASTERN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2327
Mailing Address - Country:US
Mailing Address - Phone:702-883-8950
Mailing Address - Fax:
Practice Address - Street 1:5258 S EASTERN AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2327
Practice Address - Country:US
Practice Address - Phone:702-883-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner