Provider Demographics
NPI:1518766211
Name:JUNCO GONZALEZ, FERNANDO JAVIER
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JAVIER
Last Name:JUNCO GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10097 FLAGSTAFF BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1660
Mailing Address - Country:US
Mailing Address - Phone:702-208-3156
Mailing Address - Fax:
Practice Address - Street 1:8225 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8962
Practice Address - Country:US
Practice Address - Phone:702-871-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant