| NPI | 1073086179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE ROBERT GATICALES Owner 702-292-4657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) | |
| 207QA0401X Family Medicine, Addiction Medicine | |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2019-01-10 |