Healthcare Provider Details

I. General information

NPI: 1013039072
Provider Name (Legal Business Name): VICTORIA GUERRA FARLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 MEDICAL CENTER ST STE 200
LAS VEGAS NV
89148-2421
US

IV. Provider business mailing address

6460 MEDICAL CENTER ST STE 200
LAS VEGAS NV
89148-2421
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-6647
  • Fax: 702-933-1444
Mailing address:
  • Phone: 702-255-6647
  • Fax: 702-933-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13865
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number13865
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: