Healthcare Provider Details

I. General information

NPI: 1275345498
Provider Name (Legal Business Name): KENNETH GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 W POST RD STE 110
LAS VEGAS NV
89148-2429
US

IV. Provider business mailing address

8475 MICHAEL CHERRY AVE UNIT 109
LAS VEGAS NV
89113-4516
US

V. Phone/Fax

Practice location:
  • Phone: 725-605-8954
  • Fax:
Mailing address:
  • Phone: 862-290-8243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT.12934
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: