Provider Demographics
NPI:1134830847
Name:DE GUZMAN, MELINDA
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:DE GUZMAN
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 1:860 AURELIE RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-5525
Mailing Address - Country:US
Mailing Address - Phone:702-845-5809
Mailing Address - Fax:
Practice Address - Street 1:10138 LEMON THYME ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7388
Practice Address - Country:US
Practice Address - Phone:702-845-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-23
Deactivation Date:2022-12-15
Deactivation Code:
Reactivation Date:2022-12-23
Provider Licenses
StateLicense IDTaxonomies
NVRN75515163W00000X
NV862405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse