Individual
ERNESTINA BERNADETTE GALLEGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5258 S EASTERN AVE, LAS VEGAS, NV 89119-2326
(702) 464-5080
Mailing address
5258 S EASTERN AVE, LAS VEGAS, NV 89119-2326
(702) 464-5080
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417349127
—
NV
Enumeration date
07/21/2016
Last updated
07/21/2016
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