Provider Demographics
NPI:1710273008
Name:GONCALVES, GLAUCIA GR (CST)
Entity Type:Individual
Prefix:
First Name:GLAUCIA
Middle Name:GR
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:GLAUCIA
Other - Middle Name:GR,
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:8960 W. TROPICANA AVENUE
Mailing Address - Street 2:500
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8139
Mailing Address - Country:US
Mailing Address - Phone:702-739-4263
Mailing Address - Fax:877-739-3590
Practice Address - Street 1:8960 W. TROPICANA AVENUE
Practice Address - Street 2:500
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8139
Practice Address - Country:US
Practice Address - Phone:702-739-4263
Practice Address - Fax:877-739-3590
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101801246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist