Provider Demographics
NPI:1497328850
Name:GUIKING, IRENEO JR
Entity Type:Individual
Prefix:
First Name:IRENEO
Middle Name:
Last Name:GUIKING
Suffix:JR
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 1:9444 HERSHEY LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0115
Mailing Address - Country:US
Mailing Address - Phone:702-425-0172
Mailing Address - Fax:
Practice Address - Street 1:8290 W SAHARA AVE STE 152
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8932
Practice Address - Country:US
Practice Address - Phone:702-425-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV843646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily