MEDICARE: DESIREE REBECCA GUZMAN

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	101YM0800X	Mental Health Counselor		NV

General Provider Information

NPI Number	:	1114434149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE REBECCA GUZMAN

Provider Business Mailing Address
First Line	:	3068 TARPON DR UNIT 201
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-5160
Country	:	US
Telephone Number	:	702-588-4554
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 E DESERT INN RD STE 250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3610
Country	:	US
Telephone Number	:	702-538-9474
Fax Number	:

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

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	12/28/2017

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Directions to “ DESIREE REBECCA GUZMAN ” Practice Location

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