Healthcare Provider Details

I. General information

NPI: 1932010501
Provider Name (Legal Business Name): GENTIAN DERGUTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S JONES BLVD STE H
LAS VEGAS NV
89146-3165
US

IV. Provider business mailing address

2001 S JONES BLVD STE H
LAS VEGAS NV
89146-3165
US

V. Phone/Fax

Practice location:
  • Phone: 702-367-0111
  • Fax: 702-367-0140
Mailing address:
  • Phone: 702-367-0111
  • Fax: 702-367-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: