Provider Demographics
NPI:1659161529
Name:BARZAGA BOLANOS, GILBERTO
Entity type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
Last Name:BARZAGA BOLANOS
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 1:4040 BOULDER HWY APT 1053
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2511
Mailing Address - Country:US
Mailing Address - Phone:702-588-9132
Mailing Address - Fax:
Practice Address - Street 1:4040 BOULDER HWY APT 1053
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2511
Practice Address - Country:US
Practice Address - Phone:702-588-9132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant