Healthcare Provider Details

I. General information

NPI: 1750272910
Provider Name (Legal Business Name): RAFAEL M VERA GUERRERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FLAMINGO RD STE 18
LAS VEGAS NV
89119-5244
US

IV. Provider business mailing address

5849 STATELINE WAY
LAS VEGAS NV
89110-3854
US

V. Phone/Fax

Practice location:
  • Phone: 702-478-9971
  • Fax: 702-478-9968
Mailing address:
  • Phone: 915-850-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: