Provider Demographics
NPI:1346329331
Name:GUEVARRA, LOIDA VITAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LOIDA
Middle Name:VITAN
Last Name:GUEVARRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12760 HESPERIA RD
Mailing Address - Street 2:STE A
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8305
Mailing Address - Country:US
Mailing Address - Phone:760-955-1166
Mailing Address - Fax:760-955-1499
Practice Address - Street 1:12760 HESPERIA RD
Practice Address - Street 2:STE A
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8305
Practice Address - Country:US
Practice Address - Phone:760-955-1166
Practice Address - Fax:760-955-1499
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZPBA08030OtherBLUE CROSS PROVIDER ID#
CA00A534080OtherMEDI-CAL PROVIDER ID#
CA046950OtherHEALTHNET PROVIDER ID#
CA046950OtherHEALTHNET PROVIDER ID#
CAY03540Medicare UPIN