Provider Demographics
NPI:1639678717
Name:GONZALEZ VALDEZ, GORDIANA HERM
Entity Type:Individual
Prefix:
First Name:GORDIANA
Middle Name:HERM
Last Name:GONZALEZ VALDEZ
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 1:1084 MAPLE BEND CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-8002
Mailing Address - Country:US
Mailing Address - Phone:702-268-0462
Mailing Address - Fax:
Practice Address - Street 1:1084 MAPLE BEND CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-8002
Practice Address - Country:US
Practice Address - Phone:702-268-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1401606291OtherDRIVER LICENSE