Provider Demographics
NPI:1164404968
Name:GUEVARA, NELSON
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
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 1:8780 NW 98TH CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2746
Mailing Address - Country:US
Mailing Address - Phone:305-285-5626
Mailing Address - Fax:305-285-5627
Practice Address - Street 1:3663 S MIAMI AVE FL 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-285-5626
Practice Address - Fax:305-285-5627
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90099207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36691Medicare UPIN
FL2724715-00Medicaid