Healthcare Provider Details

I. General information

NPI: 1710273008
Provider Name (Legal Business Name): GLAUCIA G.R. GONCALVES CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLAUCIA G.R, SANTOS CST

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8960 W. TROPICANA AVENUE 500
LAS VEGAS NV
89147-8139
US

IV. Provider business mailing address

8960 W. TROPICANA AVENUE 500
LAS VEGAS NV
89147-8139
US

V. Phone/Fax

Practice location:
  • Phone: 702-739-4263
  • Fax: 877-739-3590
Mailing address:
  • Phone: 702-739-4263
  • Fax: 877-739-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number101801
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: