Basic Information
| Provider Information | |||||||||
| NPI: | 1871153742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUINGON | ||||||||
| FirstName: | RALPH MARION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2712 MONROVIA DR | ||||||||
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| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891170508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026953395 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12073 FLATLANDS AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112078306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186421100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2019 | ||||||||
| LastUpdateDate: | 06/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 044301 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.