Provider Demographics
NPI:1255811139
Name:GUEVARA, PRISCILLA ANN
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name: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 1:316 GENERAL CAVAZOS BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7245
Mailing Address - Country:US
Mailing Address - Phone:361-592-9366
Mailing Address - Fax:361-595-7389
Practice Address - Street 1:316 GENERAL CAVAZOS BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7245
Practice Address - Country:US
Practice Address - Phone:361-592-9366
Practice Address - Fax:361-595-7389
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214045224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant