Healthcare Provider Details

I. General information

NPI: 1336060326
Provider Name (Legal Business Name): ALCIDES GERARDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 LONG DR
MINDEN NV
89423-7711
US

IV. Provider business mailing address

3485 LONG DR
MINDEN NV
89423-7711
US

V. Phone/Fax

Practice location:
  • Phone: 530-721-7340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberPL00641
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: