Provider Demographics
NPI:1194925842
Name:GUEVARA, ADRIANA
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:
Other - Last Name:GUEVARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6749 EL BANQUERO PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1129
Mailing Address - Country:US
Mailing Address - Phone:831-325-2807
Mailing Address - Fax:
Practice Address - Street 1:6749 EL BANQUERO PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1129
Practice Address - Country:US
Practice Address - Phone:831-332-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269741041C0700X
CA186921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194925842Medicaid
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE GROUP NUMBER
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP NUMBER