Healthcare Provider Details

I. General information

NPI: 1871109082
Provider Name (Legal Business Name): GILBERT OLIVIANO ARCIOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 E SAHARA AVE
LAS VEGAS NV
89104-3220
US

IV. Provider business mailing address

8006 ARCADIAN LN
LAS VEGAS NV
89147-3700
US

V. Phone/Fax

Practice location:
  • Phone: 725-244-4182
  • Fax:
Mailing address:
  • Phone: 510-921-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: