Provider Demographics
NPI:1437606712
Name:GUEVARA, JACQUELINE R
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57395 SAINT MARYS DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3042
Mailing Address - Country:US
Mailing Address - Phone:760-361-9359
Mailing Address - Fax:
Practice Address - Street 1:58945 BUSINESS CENTER DR
Practice Address - Street 2:SUITE D/E
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7307
Practice Address - Country:US
Practice Address - Phone:760-228-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator