Basic Information
| Provider Information | |||||||||
| NPI: | 1841342102 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUITA TABASSI DO LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6080 S FORT APACHE RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891485616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028710303 | ||||||||
| FaxNumber: | 7025620054 | ||||||||
| Practice Location | |||||||||
| Address1: | 6080 S FORT APACHE RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891485616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028710303 | ||||||||
| FaxNumber: | 7025620054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 08/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | TABASSI | ||||||||
| AuthorizedOfficialFirstName: | GUITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7028710303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 207V00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 100512287 | 05 | NV | MEDICAID |