Healthcare Provider Details

I. General information

NPI: 1073494654
Provider Name (Legal Business Name): OLIVIA GISELA GUEVARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

9 SENECA RD
WEST HARTFORD CT
06117-2246
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-7700
  • Fax:
Mailing address:
  • Phone: 860-992-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6732
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: