Provider Demographics
NPI:1477086601
Name:GUEVARA, MILDREY
Entity Type:Individual
Prefix:
First Name:MILDREY
Middle Name:
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 1:1350 SW 122ND AVE APT 113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2824
Mailing Address - Country:US
Mailing Address - Phone:786-374-1023
Mailing Address - Fax:
Practice Address - Street 1:1350 SW 122ND AVE APT 113
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2824
Practice Address - Country:US
Practice Address - Phone:786-374-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician