Provider Demographics
NPI:1285490953
Name:GUARDADO MENJIVAR, KATERIN LISBETH
Entity type:Individual
Prefix:
First Name:KATERIN
Middle Name:LISBETH
Last Name:GUARDADO MENJIVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 HAVERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3533
Mailing Address - Country:US
Mailing Address - Phone:702-581-8427
Mailing Address - Fax:
Practice Address - Street 1:3452 HAVERFORD AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3533
Practice Address - Country:US
Practice Address - Phone:702-581-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist