Provider Demographics
NPI:1174895874
Name:WENCE-MUNOZ, GERARDO (PHD, MA)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:WENCE-MUNOZ
Suffix:
Gender:M
Credentials:PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 E RUSSELL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2201
Mailing Address - Country:US
Mailing Address - Phone:702-292-7026
Mailing Address - Fax:
Practice Address - Street 1:3450 E RUSSELL RD STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2201
Practice Address - Country:US
Practice Address - Phone:702-292-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid