Provider Demographics
NPI:1538591565
Name:GONZALEZ ESCOBAR, GAMALIER (RMA (AMT))
Entity type:Individual
Prefix:MR
First Name:GAMALIER
Middle Name:
Last Name:GONZALEZ ESCOBAR
Suffix:
Gender:M
Credentials:RMA (AMT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 KIMBERLITE CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-4103
Mailing Address - Country:US
Mailing Address - Phone:775-409-0266
Mailing Address - Fax:
Practice Address - Street 1:10038 MEADOW WAY
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0482
Practice Address - Country:US
Practice Address - Phone:530-426-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538591565Medicaid