Healthcare Provider Details

I. General information

NPI: 1831800861
Provider Name (Legal Business Name): JOSE A GUEVARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 BROADWAY
SEATTLE WA
98122-3854
US

IV. Provider business mailing address

1736 S HORTON ST APT D
SEATTLE WA
98144-6301
US

V. Phone/Fax

Practice location:
  • Phone: 206-726-3495
  • Fax: 206-726-3498
Mailing address:
  • Phone: 206-349-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA61128275
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: