Provider Demographics
NPI:1720710981
Name:GUEVARRA, JUSTINE CARLO GARCIA (MD)
Entity type:Individual
Prefix:
First Name:JUSTINE CARLO
Middle Name:GARCIA
Last Name:GUEVARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 LA GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-4024
Mailing Address - Country:US
Mailing Address - Phone:570-677-5525
Mailing Address - Fax:
Practice Address - Street 1:701 E CHANNEL ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2628
Practice Address - Country:US
Practice Address - Phone:209-373-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT227297390200000X
CAA201560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program