Healthcare Provider Details

I. General information

NPI: 1356625131
Provider Name (Legal Business Name): NATALIE M GUEVARA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5613
US

IV. Provider business mailing address

1801 W OLYMPIC BLVD # 1270
PASADENA CA
91199-0001
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-4900
  • Fax: 702-476-4949
Mailing address:
  • Phone: 702-791-1454
  • Fax: 702-946-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPN001318
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: