Provider Demographics
NPI:1336673193
Name:GUEVARA, ALBERTO
Entity Type:Individual
Prefix:
First Name:ALBERTO
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:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:STANFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97875-0385
Mailing Address - Country:US
Mailing Address - Phone:541-701-5900
Mailing Address - Fax:
Practice Address - Street 1:16144 SE HAPPY VALLEY TOWN CENTER DR STE 214
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4257
Practice Address - Country:US
Practice Address - Phone:503-658-7715
Practice Address - Fax:503-658-7181
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59270175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath