Healthcare Provider Details

I. General information

NPI: 1730004169
Provider Name (Legal Business Name): GRACE BAUTISTA SUGUITAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PILOT RD STE 250
LAS VEGAS NV
89119-3514
US

IV. Provider business mailing address

6421 DUNDOCK AVE
LAS VEGAS NV
89122-7602
US

V. Phone/Fax

Practice location:
  • Phone: 702-982-3292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number876132
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: