Provider Demographics
NPI:1871312553
Name:BAUTA GOMEZ, REINA (MEDICAL MASSAGE LMT)
Entity type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:BAUTA GOMEZ
Suffix:
Gender:F
Credentials:MEDICAL MASSAGE LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W LAKE MEAD PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7071
Mailing Address - Country:US
Mailing Address - Phone:702-640-7158
Mailing Address - Fax:
Practice Address - Street 1:133 W LAKE MEAD PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7071
Practice Address - Country:US
Practice Address - Phone:702-640-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVNVMT.8237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist