Provider Demographics
NPI:1578123535
Name:ALVIZO TAMAYO, GUADALUPE LETICIA
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:LETICIA
Last Name:ALVIZO TAMAYO
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 1:9520 PROTOTYPE CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5916
Mailing Address - Country:US
Mailing Address - Phone:775-342-7915
Mailing Address - Fax:775-852-6321
Practice Address - Street 1:3700 GRANT DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5474
Practice Address - Country:US
Practice Address - Phone:775-829-4700
Practice Address - Fax:775-829-4710
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV235Z00000XMedicaid