Provider Demographics
NPI:1841342102
Name:GUITA TABASSI DO LTD
Entity type:Organization
Organization Name:GUITA TABASSI DO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-871-0303
Mailing Address - Street 1:6080 S FORT APACHE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5616
Mailing Address - Country:US
Mailing Address - Phone:702-871-0303
Mailing Address - Fax:702-562-0054
Practice Address - Street 1:6080 S FORT APACHE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5616
Practice Address - Country:US
Practice Address - Phone:702-871-0303
Practice Address - Fax:702-562-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512287Medicaid
NV100512287Medicaid