Individual
MS. DIANE GUSTAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
8777 W MAULE AVENUE, 2074, LAS VEGAS, NV 89148-4894
(631) 839-2462
Mailing address
8777 W MAULE AVE, 2074, LAS VEGAS, NV 89148-4868
(631) 839-2462
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
04/01/2011
Last updated
04/01/2011
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