Provider Demographics
NPI:1639365364
Name:GUEVARA, YELITZA
Entity type:Individual
Prefix:
First Name:YELITZA
Middle Name:
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:PLAZA DEL PARQUE # 1500
Mailing Address - Street 2:SUITE 120 AVENUE COMERIO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3976
Mailing Address - Country:US
Mailing Address - Phone:787-740-0660
Mailing Address - Fax:787-740-0718
Practice Address - Street 1:PLAZA DEL PARQUE # 1500
Practice Address - Street 2:SUITE 120 AVENUE COMERIO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3976
Practice Address - Country:US
Practice Address - Phone:787-740-0660
Practice Address - Fax:787-740-0718
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3453183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3453OtherPHARMACY TECHNICIAN