Provider Demographics
NPI:1568032548
Name:GUANAROCA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:GUANAROCA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXEIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARES-GATTORNO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:725-400-6444
Mailing Address - Street 1:68 INCLINE VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-0693
Mailing Address - Country:US
Mailing Address - Phone:725-400-6444
Mailing Address - Fax:
Practice Address - Street 1:5130 S PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-1201
Practice Address - Country:US
Practice Address - Phone:725-205-3203
Practice Address - Fax:725-205-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1568032548Medicaid