Provider Demographics
NPI:1396798278
Name:GUEVARA, MARIA N (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:N
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:MD
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 1452
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-1223
Mailing Address - Country:US
Mailing Address - Phone:509-547-2204
Mailing Address - Fax:509-545-3960
Practice Address - Street 1:515 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3737
Practice Address - Country:US
Practice Address - Phone:509-547-2204
Practice Address - Fax:509-545-3960
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043989208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8407335Medicaid
WAG8852925Medicare PIN
H90348Medicare UPIN