Provider Demographics
NPI:1578838496
Name:GUEVARA, STEPHANIE T (MAED)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:T
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 COMPTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-2805
Mailing Address - Country:US
Mailing Address - Phone:310-783-4677
Mailing Address - Fax:323-566-1638
Practice Address - Street 1:10221 COMPTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-2805
Practice Address - Country:US
Practice Address - Phone:310-783-4677
Practice Address - Fax:323-566-1638
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator