Provider Demographics
NPI:1427588599
Name:GUEVARRA, CHRISTLE CUELLAR (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTLE
Middle Name:CUELLAR
Last Name:GUEVARRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9496 ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7542
Mailing Address - Country:US
Mailing Address - Phone:810-209-8882
Mailing Address - Fax:949-862-8090
Practice Address - Street 1:9496 ROSEMARY LN
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7542
Practice Address - Country:US
Practice Address - Phone:810-209-8882
Practice Address - Fax:949-862-8090
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2768207Q00000X
PAOT017953207Q00000X
MI5101026490207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine