Healthcare Provider Details

I. General information

NPI: 1023849890
Provider Name (Legal Business Name): GALLARON GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9788 GILESPIE ST STE D-426
LAS VEGAS NV
89183-7604
US

IV. Provider business mailing address

1136 VIA ROCCA
HENDERSON NV
89052-0520
US

V. Phone/Fax

Practice location:
  • Phone: 702-588-9721
  • Fax:
Mailing address:
  • Phone: 702-588-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JERRY J GALLARON
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 702-588-9723