Provider Demographics
NPI:1538460886
Name:GUEVARRA, JASON
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:GUEVARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:NOEL
Other - Middle Name:JASON
Other - Last Name:GUEVARRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:749 NOB CIR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3811
Mailing Address - Country:US
Mailing Address - Phone:760-805-2080
Mailing Address - Fax:
Practice Address - Street 1:960 VINE ST APT 211
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4276
Practice Address - Country:US
Practice Address - Phone:760-231-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD9390253172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker