Provider Demographics
NPI:1184246126
Name:GUEVARA, CAMILO ERNESTO (RN)
Entity type:Individual
Prefix:
First Name:CAMILO
Middle Name:ERNESTO
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6704
Mailing Address - Country:US
Mailing Address - Phone:903-931-3242
Mailing Address - Fax:903-212-7121
Practice Address - Street 1:2020 BILL OWENS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6243
Practice Address - Country:US
Practice Address - Phone:903-212-7808
Practice Address - Fax:903-212-7121
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX848601163WC1500X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health