Healthcare Provider Details

I. General information

NPI: 1114449832
Provider Name (Legal Business Name): WEST GALENO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 W CRAIG RD STE 9
NORTH LAS VEGAS NV
89032-5105
US

IV. Provider business mailing address

3365 W CRAIG RD STE 9
NORTH LAS VEGAS NV
89032-5105
US

V. Phone/Fax

Practice location:
  • Phone: 702-980-5898
  • Fax:
Mailing address:
  • Phone: 702-980-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberNV8240
License Number StateNV

VIII. Authorized Official

Name: MAIRELIS RODRIGUEZ
Title or Position: PRESIDENT
Credential: ARNP
Phone: 702-980-5898