Healthcare Provider Details

I. General information

NPI: 1003729310
Provider Name (Legal Business Name): GANSO PROCYON CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 W CHARLESTON BLVD
LAS VEGAS NV
89102-1932
US

IV. Provider business mailing address

3202 W CHARLESTON BLVD STE 3
LAS VEGAS NV
89102-1932
US

V. Phone/Fax

Practice location:
  • Phone: 702-666-7880
  • Fax:
Mailing address:
  • Phone: 702-666-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ARLETTE GANSO
Title or Position: MANAGER
Credential: APRN
Phone: 702-666-7880