Provider Demographics
NPI:1689050650
Name:VASQUEZ GUEVARA, MICHELLE ARELY
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:ARELY
Last Name:VASQUEZ 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 1:247 W VERDUGO AVE APT F
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2884
Mailing Address - Country:US
Mailing Address - Phone:213-858-7743
Mailing Address - Fax:
Practice Address - Street 1:6736 LAUREL CANYON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1576
Practice Address - Country:US
Practice Address - Phone:818-755-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program