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General NPI Number Information
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NPI Number | 1184612376
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Entity Type | Individual
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Provider Name | ALFREDO GUEVARA JR. MD FACS
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 507 N WESTERN AVE
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City | NOGALES
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State | AZ
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Zip | 85621-2060
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Country | US
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Telephone | 520-761-3103
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Fax | 520-287-4862
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Provider Business Mailing Address
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Address Line | 507 N WESTERN AVE
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City | NOGALES
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State | AZ
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Zip | 85621-2060
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Country | US
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Telephone | 520-761-3103
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Fax | 520-287-4862
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 11435
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License Number State | AZ
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