Provider Demographics
NPI:1528364619
Name:GORRE, VILMA MANALO
Entity Type:Individual
Prefix:MS
First Name:VILMA
Middle Name:MANALO
Last Name:GORRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 MISTY MORNING DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0600
Mailing Address - Country:US
Mailing Address - Phone:702-646-8233
Mailing Address - Fax:
Practice Address - Street 1:5210 MISTY MORNING DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0600
Practice Address - Country:US
Practice Address - Phone:702-646-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1208UNLVMedicaid