Healthcare Provider Details

I. General information

NPI: 1124341755
Provider Name (Legal Business Name): AZURE GUERRA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S BEARDEN DR SUITE 201
LAS VEGAS NV
89106
US

IV. Provider business mailing address

PO BOX 36605
LAS VEGAS NV
89133
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-3428
  • Fax: 702-476-9434
Mailing address:
  • Phone: 702-202-3431
  • Fax: 702-202-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number11608
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11608
License Number StateNV

VIII. Authorized Official

Name: TONYA RUSHING
Title or Position: CONSULTANT
Credential:
Phone: 702-202-3431