Healthcare Provider Details

I. General information

NPI: 1841342102
Provider Name (Legal Business Name): GUITA TABASSI DO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 S FORT APACHE RD SUITE 110
LAS VEGAS NV
89148-5616
US

IV. Provider business mailing address

6080 S FORT APACHE RD SUITE 110
LAS VEGAS NV
89148-5616
US

V. Phone/Fax

Practice location:
  • Phone: 702-871-0303
  • Fax: 702-562-0054
Mailing address:
  • Phone: 702-871-0303
  • Fax: 702-562-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: GUITA TABASSI
Title or Position: PRESIDENT
Credential: DO
Phone: 702-871-0303