Healthcare Provider Details

I. General information

NPI: 1033927132
Provider Name (Legal Business Name): ADIAN LADRON DE GUEVARA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E 4TH AVE
HIALEAH FL
33010-4103
US

IV. Provider business mailing address

63 NW 74TH AVE
MIAMI FL
33126-4132
US

V. Phone/Fax

Practice location:
  • Phone: 786-438-8802
  • Fax:
Mailing address:
  • Phone: 786-438-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number11036882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: