Provider Demographics
NPI:1437493715
Name:GALLEGOS, MARCI CAROLENA
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:CAROLENA
Last Name:GALLEGOS
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 1:9308 MOUNTAIN CLIFFS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7831
Mailing Address - Country:US
Mailing Address - Phone:702-439-7371
Mailing Address - Fax:
Practice Address - Street 1:9308 MOUNTAIN CLIFFS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7831
Practice Address - Country:US
Practice Address - Phone:702-439-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNA024505172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker