Healthcare Provider Details

I. General information

NPI: 1033397625
Provider Name (Legal Business Name): INTERNATIONAL HEALING AND HYPERBARIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 W CHARLESTON BLVD
LAS VEGAS NV
89135-1151
US

IV. Provider business mailing address

8430 W LAKE MEAD BLVD STE 100
LAS VEGAS NV
89128-7674
US

V. Phone/Fax

Practice location:
  • Phone: 702-576-9820
  • Fax: 702-576-9801
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number11508
License Number StateNV

VIII. Authorized Official

Name: HORACE P GUERRA
Title or Position: MANAGER
Credential: MD
Phone: 702-921-6829