Provider Demographics
NPI:1578216842
Name:GOLA-CALLARD, VICKY LEE
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LEE
Last Name:GOLA-CALLARD
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 1:3301 N BUFFALO DR STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7449
Mailing Address - Country:US
Mailing Address - Phone:702-932-3500
Mailing Address - Fax:
Practice Address - Street 1:3301 N BUFFALO DR STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7449
Practice Address - Country:US
Practice Address - Phone:702-932-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant