Provider Demographics
NPI:1659703122
Name:GERA, RITA PAMELA A
Entity Type:Individual
Prefix:
First Name:RITA PAMELA
Middle Name:A
Last Name:GERA
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 1:5050 TAMARUS ST APT 350
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2047
Mailing Address - Country:US
Mailing Address - Phone:702-265-3092
Mailing Address - Fax:
Practice Address - Street 1:5050 TAMARUS ST APT 350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2047
Practice Address - Country:US
Practice Address - Phone:702-265-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVOTHERMedicaid