Provider Demographics
NPI:1043771355
Name:GUEVARA, KEVIN AQUINO
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:AQUINO
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 CITATION DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-4800
Mailing Address - Country:US
Mailing Address - Phone:573-999-4634
Mailing Address - Fax:
Practice Address - Street 1:3808 CITATION DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-4800
Practice Address - Country:US
Practice Address - Phone:573-999-4634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program