Provider Demographics
NPI:1558198457
Name:GUEVARA, LUSMELYS TRINIDAD (CMA)
Entity type:Individual
Prefix:MRS
First Name:LUSMELYS
Middle Name:TRINIDAD
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13482 SAGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8490
Mailing Address - Country:US
Mailing Address - Phone:786-867-4305
Mailing Address - Fax:407-507-3874
Practice Address - Street 1:3480 POLYNESIAN ISLE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4654
Practice Address - Country:US
Practice Address - Phone:407-507-2615
Practice Address - Fax:407-507-3874
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2019061204191744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty