Provider Demographics
NPI:1023516705
Name:GALVEZ, BLANCA IRIS
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:IRIS
Last Name:GALVEZ
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 1:2675 S NELLIS BLVD APT 1164
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2071
Mailing Address - Country:US
Mailing Address - Phone:702-665-9639
Mailing Address - Fax:
Practice Address - Street 1:2675 S NELLIS BLVD APT 1164
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2071
Practice Address - Country:US
Practice Address - Phone:702-665-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2102790402OtherDIRVER LICENSE