Healthcare Provider Details

I. General information

NPI: 1346062015
Provider Name (Legal Business Name): HECTOR ELIZARRARAS GUEVARA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date: 08/12/2026
Reactivation Date: 09/23/2026

III. Provider practice location address

9101 WHITTIER BLVD
PICO RIVERA CA
90660-2443
US

IV. Provider business mailing address

9101 WHITTIER BLVD
PICO RIVERA CA
90660-2443
US

V. Phone/Fax

Practice location:
  • Phone: 562-801-4626
  • Fax:
Mailing address:
  • Phone: 562-801-4626
  • Fax:

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: