Provider Demographics
NPI:1689351967
Name:ALFONSO GUEVARA, LEYDI LAURA
Entity Type:Individual
Prefix:
First Name:LEYDI
Middle Name:LAURA
Last Name:ALFONSO 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 1:985 W 67TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6466
Mailing Address - Country:US
Mailing Address - Phone:786-674-7703
Mailing Address - Fax:
Practice Address - Street 1:985 W 67TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6466
Practice Address - Country:US
Practice Address - Phone:786-674-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374U00000XNursing Service Related ProvidersHome Health Aide