1750687281 NPI number — MR. ANTONIO JORGE GILMORE M.S.W/L.S.W-PENDING

Table of content: MS. ARLENE JOAN JACOBSEN LCSW (NPI 1285734442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750687281 NPI number — MR. ANTONIO JORGE GILMORE M.S.W/L.S.W-PENDING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILMORE
Provider First Name:
ANTONIO
Provider Middle Name:
JORGE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W/L.S.W-PENDING
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750687281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9101 W SAHARA AVE
Provider Second Line Business Mailing Address:
STE 105 #190
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-5772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-266-5636
Provider Business Mailing Address Fax Number:
702-869-8870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4285 N RANCHO DR
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89130-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-385-5331
Provider Business Practice Location Address Fax Number:
702-385-5678
Provider Enumeration Date:
02/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 225400000X , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104100000X , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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