Provider Demographics
NPI:1710531504
Name:EVELYN CASTRO GUEVARA
Entity Type:Organization
Organization Name:EVELYN CASTRO GUEVARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-592-6132
Mailing Address - Street 1:P.O. BOX 5707
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349
Mailing Address - Country:US
Mailing Address - Phone:760-592-6132
Mailing Address - Fax:858-430-3143
Practice Address - Street 1:AV. FRANCISCO I. MADERO 1268-A
Practice Address - Street 2:
Practice Address - City:MEXICALI
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21100
Practice Address - Country:MX
Practice Address - Phone:760-592-6132
Practice Address - Fax:858-430-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty