Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | ||
Y | 104100000X | Social Worker |
NPI | 1528477551 |
---|---|
Provider Name | Annette Guajardo |
First Address | Las Vegas, NV 89183-4655 |
Second Address | Las Vegas, NV 89183-4655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2014 |
Last Update Date | 04/08/2014 |