Basic Information
Provider Information
NPI: 1487131454
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GALVEZ
FirstName: MARIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4611 DEER FOREST AVE
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891397641
CountryCode: US
TelephoneNumber: 7022719219
FaxNumber:  
Practice Location
Address1: 5000 W OAKEY BLVD
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891463393
CountryCode: US
TelephoneNumber: 7027332890
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/23/2018
LastUpdateDate: 07/23/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
372500000X NVN Nursing Service Related ProvidersChore Provider 
372600000X NVN Nursing Service Related ProvidersAdult Companion 
3747A0650X NVN Nursing Service Related ProvidersTechnicianAttendant Care Provider
376J00000X NVN Nursing Service Related ProvidersHomemaker 
3747P1801X NVY Nursing Service Related ProvidersTechnicianPersonal Care Attendant

No ID Information.


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