Provider Demographics
NPI:1598058745
Name:GAONA-GUEVARA, KIMBERLY K (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:K
Last Name:GAONA-GUEVARA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:GAONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:18308 MASI LOOP
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5564
Mailing Address - Country:US
Mailing Address - Phone:512-826-2282
Mailing Address - Fax:
Practice Address - Street 1:18308 MASI LOOP
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5564
Practice Address - Country:US
Practice Address - Phone:512-826-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT111223225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist