Healthcare Provider Details

I. General information

NPI: 1548959661
Provider Name (Legal Business Name): CHRISTINA MARIE GUEVARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST STE C
MODESTO CA
95350-5814
US

IV. Provider business mailing address

3530 S GRATTON RD
DENAIR CA
95316-9743
US

V. Phone/Fax

Practice location:
  • Phone: 209-552-2720
  • Fax:
Mailing address:
  • Phone: 209-284-7587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number125693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: