Provider Demographics
NPI:1659070290
Name:GUEVARA, ASHLEY KRISTINE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KRISTINE
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 1:480 AMADOR LN UNIT 6
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-8334
Mailing Address - Country:US
Mailing Address - Phone:305-804-2005
Mailing Address - Fax:
Practice Address - Street 1:900 SW 8TH ST STE CU-2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3751
Practice Address - Country:US
Practice Address - Phone:305-858-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4435171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty