Provider Demographics
NPI:1508237587
Name:DUNGO, GERALD GUEVARRA (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:GUEVARRA
Last Name:DUNGO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 BLUEBELL BROOK ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4538
Mailing Address - Country:US
Mailing Address - Phone:714-390-3386
Mailing Address - Fax:
Practice Address - Street 1:1550 N GREEN VALLEY PKWY STE 360
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7110
Practice Address - Country:US
Practice Address - Phone:702-644-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003197363LF0000X
NVAPRN002363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1508237587Medicaid
NV1508237587Medicaid