Healthcare Provider Details

I. General information

NPI: 1790043420
Provider Name (Legal Business Name): EUGENIO MOISES GUEVARA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 319
HIALEAH FL
33013-3849
US

IV. Provider business mailing address

777 E 25TH ST STE 319
HIALEAH FL
33013-3849
US

V. Phone/Fax

Practice location:
  • Phone: 305-693-8585
  • Fax: 305-693-8595
Mailing address:
  • Phone: 305-693-8585
  • Fax: 305-693-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EUGENIO MOISES GUEVARA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-693-8585