Provider Demographics
NPI:1497890834
Name:GUEVARA, ELBA
Entity Type:Individual
Prefix:
First Name:ELBA
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 1:40 CALLE JOSE I QUINTON
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2408
Mailing Address - Country:US
Mailing Address - Phone:787-825-1268
Mailing Address - Fax:787-825-8619
Practice Address - Street 1:40 CALLE JOSE I QUINTON
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2408
Practice Address - Country:US
Practice Address - Phone:787-825-1268
Practice Address - Fax:787-825-8619
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2254183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician