MEDICARE: KATERIN LISBETH GUARDADO MENJIVAR

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	174400000X	Specialist		NV

General Provider Information

NPI Number	:	1285490953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATERIN LISBETH GUARDADO MENJIVAR

Provider Business Mailing Address
First Line	:	3452 HAVERFORD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3533
Country	:	US
Telephone Number	:	702-581-8427
Fax Number	:

Provider Business Practice Location Address
First Line	:	3452 HAVERFORD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3533
Country	:	US
Telephone Number	:	702-581-8427
Fax Number	:

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

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	02/21/2024

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Directions to “ KATERIN LISBETH GUARDADO MENJIVAR ” Practice Location

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