Provider Demographics
NPI:1417940032
Name:GONDY, ANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:GONDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 PINTO LN STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4005
Mailing Address - Country:US
Mailing Address - Phone:702-978-7617
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:2800 N TENAYA WAY STE 203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1100
Practice Address - Country:US
Practice Address - Phone:702-978-8900
Practice Address - Fax:702-978-7617
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7945207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV880400613OtherOB-GYN
NV1417940032Medicaid
NV7945OtherNV MEDICAL LICENSE NUMBER
NV002019959Medicaid