Basic Information
| Provider Information | |||||||||
| NPI: | 1174037709 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEATHER GAMEZ LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2654 W HORIZON RIDGE PKWY | ||||||||
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| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890522803 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 SAINT ROSE PKWY | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890523839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026165000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | GAMEZ | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CERTIFIED SURGICAL FIRST ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7025742114 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CSFA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | 171138 | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.