Provider Demographics
NPI:1427732619
Name:GUEVARA, LUZ ANGELICA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:ANGELICA
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 1:215 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1939
Mailing Address - Country:US
Mailing Address - Phone:903-931-3784
Mailing Address - Fax:
Practice Address - Street 1:215 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1939
Practice Address - Country:US
Practice Address - Phone:903-931-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle