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General NPI Number Information
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NPI Number | 1427567049
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Entity Type | Individual
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Provider Name | JACQUELYNN BANABAN GUEVARRA AG-ACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 3751 KATELLA AVE
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3113
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Country | US
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Telephone | 562-598-1311
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Fax |
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Provider Business Mailing Address
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Address Line | 7421 SUSAN CIR
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City | LA PALMA
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State | CA
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Zip | 90623-1325
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Country | US
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Telephone | 808-349-8152
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 95007291
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License Number State | CA
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