MEDICARE: ISHA GUICE

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1316202880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISHA GUICE

Provider Business Mailing Address
First Line	:	4145 RIVA DE TIERRA LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2518
Country	:	US
Telephone Number	:	219-545-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4145 RIVA DE TIERRA LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2518
Country	:	US
Telephone Number	:	219-545-7040
Fax Number	:

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

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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Directions to “ ISHA GUICE ” Practice Location

Language	Start Address	Practice Location

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