Provider Demographics
NPI:1265516694
Name:GUEVARA, GERARDO (DC)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 INDIANA AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4225
Mailing Address - Country:US
Mailing Address - Phone:951-248-9240
Mailing Address - Fax:
Practice Address - Street 1:6700 INDIANA AVE STE 145
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4225
Practice Address - Country:US
Practice Address - Phone:951-248-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU44115Medicare UPIN
CADC0217020Medicare ID - Type Unspecified