Provider Demographics
NPI:1932186913
Name:LOIDA V. GUEVARRA, M.D., INC.
Entity Type:Organization
Organization Name:LOIDA V. GUEVARRA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOIDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:GUEVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-955-1166
Mailing Address - Street 1:12760 HESPERIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5806
Mailing Address - Country:US
Mailing Address - Phone:760-955-1166
Mailing Address - Fax:760-955-1499
Practice Address - Street 1:12760 HESPERIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5806
Practice Address - Country:US
Practice Address - Phone:760-955-1166
Practice Address - Fax:760-955-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53408261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA805219OtherAETNA
CA00A534080Medicaid
CA046950OtherHEALTHNET
CAA53408OtherBLUE SHIELD
CA01991-0023OtherPACIFICARE
CA05256000004OtherIVHP
CA00A534080Medicaid
CA00A534082Medicare ID - Type Unspecified