Healthcare Provider Details

I. General information

NPI: 1700707098
Provider Name (Legal Business Name): MS. MIKAELA VILLOSILLO GUEVARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKA GUEVARRA

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S MCDOWELL BLVD
PETALUMA CA
94954-5473
US

IV. Provider business mailing address

5786 BELLEVIEW AVE APT B
SACRAMENTO CA
95824-2172
US

V. Phone/Fax

Practice location:
  • Phone: 707-699-6100
  • Fax: 707-699-6050
Mailing address:
  • Phone: 707-699-6100
  • Fax: 707-699-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: