Provider Demographics
NPI:1316124662
Name:GUEVARA, MARIA RITA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:RITA
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 1:12253 DEHOUGNE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-5611
Mailing Address - Country:US
Mailing Address - Phone:310-386-4879
Mailing Address - Fax:
Practice Address - Street 1:12253 DEHOUGNE ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5611
Practice Address - Country:US
Practice Address - Phone:310-386-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102275207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy