Provider Demographics
NPI:1043480155
Name:TOMA, BEATRIZ
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:TOMA
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 1:4160 S PECOS RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5025
Mailing Address - Country:US
Mailing Address - Phone:702-641-8645
Mailing Address - Fax:
Practice Address - Street 1:4160 S PECOS RD
Practice Address - Street 2:SUITE 17
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5025
Practice Address - Country:US
Practice Address - Phone:702-641-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVGF25401000251B00000X
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management