Provider Demographics
NPI:1629412531
Name:GUEVARA, ERNESTO JOSE (MD MPH)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:JOSE
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GILBERT PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1539
Mailing Address - Country:US
Mailing Address - Phone:954-864-1059
Mailing Address - Fax:
Practice Address - Street 1:3544 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1005
Practice Address - Country:US
Practice Address - Phone:718-920-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine