Provider Demographics
NPI:1316380959
Name:GARCIA, GUSTAVO OSEI (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:OSEI
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E DESERT INN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3609
Mailing Address - Country:US
Mailing Address - Phone:702-731-1616
Mailing Address - Fax:702-734-4900
Practice Address - Street 1:2800 E DESERT INN RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-731-1616
Practice Address - Fax:702-734-4900
Is Sole Proprietor?:No
Enumeration Date:2013-04-13
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV17945207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV17945OtherNV MEDICAL LICENSE