Provider Demographics
NPI:1205551314
Name:GONZALEZ, GENESIS A
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:A
Last Name:GONZALEZ
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 1:2600 ARVILLE ST APT B4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5742
Mailing Address - Country:US
Mailing Address - Phone:702-505-5126
Mailing Address - Fax:
Practice Address - Street 1:2600 ARVILLE ST APT B4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5742
Practice Address - Country:US
Practice Address - Phone:702-505-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider