Healthcare Provider Details

I. General information

NPI: 1306115951
Provider Name (Legal Business Name): ANDREW RYAN GUILLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 W SAHARA AVE A-110
LAS VEGAS NV
89146-0842
US

IV. Provider business mailing address

2161 RUNNING RIVER RD
HENDERSON NV
89074-4230
US

V. Phone/Fax

Practice location:
  • Phone: 702-365-0600
  • Fax: 702-365-0602
Mailing address:
  • Phone: 702-300-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: