Provider Demographics
NPI:1871023580
Name:GUEVARA, NATALIA (DMD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690-0784
Mailing Address - Country:US
Mailing Address - Phone:787-509-6521
Mailing Address - Fax:
Practice Address - Street 1:1005 AVE GENERAL RAMEY STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:PR
Practice Address - Zip Code:00690-1109
Practice Address - Country:US
Practice Address - Phone:787-509-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics