Healthcare Provider Details

I. General information

NPI: 1447794466
Provider Name (Legal Business Name): INCERA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10885 S EASTERN AVE #100
HENDERSON NV
89052-5857
US

IV. Provider business mailing address

4030 S JONES BLVD #32169
LAS VEGAS NV
89173-8801
US

V. Phone/Fax

Practice location:
  • Phone: 702-419-9977
  • Fax: 702-921-0222
Mailing address:
  • Phone: 702-624-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number11608
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number11608
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number6826335-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN001889
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11608
License Number StateNV

VIII. Authorized Official

Name: HORACE GUERRA IV
Title or Position: OWNER
Credential: MD
Phone: 702-809-1171