Individual
TOM RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1455 E TROPICANA AVE STE 175B, LAS VEGAS, NV 89119-6507
(702) 893-2002
(702) 369-3334
Mailing address
1455 E TROPICANA AVE STE 175B, LAS VEGAS, NV 89119-6507
(702) 893-2002
(702) 369-3334
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
2000558-062-101
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
464617191
—
NV
Enumeration date
09/01/2016
Last updated
09/01/2016
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