Provider Demographics
NPI:1306558945
Name:GUEVARA, ADRIAN (CPT)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:ADRIAN
Other - Middle Name:
Other - Last Name:GUEVARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8551 79TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1101
Mailing Address - Country:US
Mailing Address - Phone:929-312-6515
Mailing Address - Fax:
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000977183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician