Provider Demographics
NPI:1972921674
Name:CAMACHO-GALVAN, GEOVANNI J (RT (R))
Entity type:Individual
Prefix:
First Name:GEOVANNI
Middle Name:J
Last Name:CAMACHO-GALVAN
Suffix:
Gender:M
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 E OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-1859
Mailing Address - Country:US
Mailing Address - Phone:702-306-0325
Mailing Address - Fax:
Practice Address - Street 1:6175 E OWENS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-1859
Practice Address - Country:US
Practice Address - Phone:702-306-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV462333247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
462333OtherAMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS