Provider Demographics
NPI:1770355067
Name:GARRIDO SEGUIN, CHARLES RALPH
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:RALPH
Last Name:GARRIDO SEGUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9243 WERTZ AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2672
Mailing Address - Country:US
Mailing Address - Phone:702-499-0739
Mailing Address - Fax:
Practice Address - Street 1:6930 S CIMARRON RD STE 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2135
Practice Address - Country:US
Practice Address - Phone:702-476-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV832512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily