MEDICARE: AMANDA GUEVARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA65055	CA

General Provider Information

NPI Number	:	1174357255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA GUEVARA

Provider Business Mailing Address
First Line	:	18111 BROOKHURST ST STE 6100
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6728
Country	:	US
Telephone Number	:	657-241-9755
Fax Number	:	714-907-4407

Provider Business Practice Location Address
First Line	:	18111 BROOKHURST ST STE 6100
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6728
Country	:	US
Telephone Number	:	657-241-9755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	12/29/2025

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Directions to “ AMANDA GUEVARA ” Practice Location

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