MEDICARE: DAISEL GUEVARA GONZALEZ NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	843318	NV

General Provider Information

NPI Number	:	1073026506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISEL GUEVARA GONZALEZ NP

Provider Business Mailing Address
First Line	:	1820 E LAKE MEAD BLVD STE M
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7134
Country	:	US
Telephone Number	:	702-475-4752
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 E LAKE MEAD BLVD STE M
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7134
Country	:	US
Telephone Number	:	702-475-4352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	10/14/2025

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