Provider Demographics
NPI:1295174522
Name:QUERIMIT, CHRISTINE GUEVARA (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:GUEVARA
Last Name:QUERIMIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:GUZMAN
Other - Last Name:GUEVARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:702-838-1456
Practice Address - Street 1:4730 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2703
Practice Address - Country:US
Practice Address - Phone:520-290-0300
Practice Address - Fax:520-298-9230
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ246168Medicaid