Provider Demographics
NPI:1699337782
Name:GILL, DALVIN LARAY
Entity type:Individual
Prefix:
First Name:DALVIN
Middle Name:LARAY
Last Name:GILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 W CHARLESTON BLVD STE 21
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1930
Mailing Address - Country:US
Mailing Address - Phone:702-330-7844
Mailing Address - Fax:
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 21
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1930
Practice Address - Country:US
Practice Address - Phone:702-330-7844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant