Provider Demographics
NPI:1790555928
Name:CAIN, GREG (MASTERS IN EDUCATION)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:CAIN
Suffix:
Gender:M
Credentials:MASTERS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 ALAN SHEPARD ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6005
Mailing Address - Country:US
Mailing Address - Phone:760-224-9998
Mailing Address - Fax:
Practice Address - Street 1:4361 VERONA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2118
Practice Address - Country:US
Practice Address - Phone:760-224-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV86-2111897177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging