Provider Demographics
NPI:1871575332
Name:GUARNERA, SALVATORE M (MD)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:M
Last Name:GUARNERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43813
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89116-1813
Mailing Address - Country:US
Mailing Address - Phone:702-460-2304
Mailing Address - Fax:702-475-5926
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 555
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-255-5903
Practice Address - Fax:702-255-0001
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6771207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019431Medicaid
NV7470543OtherAETNA GROUP PIN
NVNV9223OtherBCBS NV PIN
NV4421419OtherAETNA INDIV PIN
NV7470543OtherAETNA GROUP PIN
NVVWJBKR01Medicare ID - Type UnspecifiedINDIVIDUAL ID
NV4421419OtherAETNA INDIV PIN