Provider Demographics
NPI:1003162900
Name:TARASOVA, GALINA ALEXANDROVMA
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:ALEXANDROVMA
Last Name:TARASOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 GALLY RD
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-2511
Mailing Address - Country:US
Mailing Address - Phone:702-418-5743
Mailing Address - Fax:
Practice Address - Street 1:560 GALLY RD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-2511
Practice Address - Country:US
Practice Address - Phone:702-418-5743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-28
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner