Provider Demographics
NPI:1114544566
Name:DIGAN, GAMALIEL
Entity Type:Individual
Prefix:
First Name:GAMALIEL
Middle Name:
Last Name:DIGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 E CHARLESTON BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6666
Mailing Address - Country:US
Mailing Address - Phone:702-769-1126
Mailing Address - Fax:
Practice Address - Street 1:3100 E CHARLESTON BLVD STE 113
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6666
Practice Address - Country:US
Practice Address - Phone:702-769-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health