Provider Demographics
NPI:1376184424
Name:LOPEZ AVILEZ, GUISSELL
Entity Type:Individual
Prefix:
First Name:GUISSELL
Middle Name:
Last Name:LOPEZ AVILEZ
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 1:1127 EMERALD STONE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-3032
Mailing Address - Country:US
Mailing Address - Phone:702-743-1358
Mailing Address - Fax:702-359-4623
Practice Address - Street 1:5400 W CHEYENNE AVE APT 2037
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4745
Practice Address - Country:US
Practice Address - Phone:925-446-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant