Provider Demographics
NPI:1326613811
Name:GALLEGOS, BENJAMIN ARCEO JR
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ARCEO
Last Name:GALLEGOS
Suffix:JR
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 1:476 ACCELERANDO WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-2675
Mailing Address - Country:US
Mailing Address - Phone:949-295-3368
Mailing Address - Fax:
Practice Address - Street 1:4850 W FLAMINGO RD STE 25
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3707
Practice Address - Country:US
Practice Address - Phone:702-871-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV840851374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV840851OtherSTATE OF BOARD OF NURSING