Healthcare Provider Details

I. General information

NPI: 1598703506
Provider Name (Legal Business Name): GUADALUPE MEDICAL CENTER/OKAMOTO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 E CHARLESTON BLVD
LAS VEGAS NV
89104-1708
US

IV. Provider business mailing address

1219 E CHARLESTON BLVD
LAS VEGAS NV
89104-1708
US

V. Phone/Fax

Practice location:
  • Phone: 702-633-5410
  • Fax: 702-320-1639
Mailing address:
  • Phone: 702-633-5410
  • Fax: 702-320-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA ALDANA
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-633-5410