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General NPI Number Information
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NPI Number | 1427588599
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Entity Type | Individual
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Provider Name | CHRISTLE CUELLAR GUEVARRA DO
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Gender | Female
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9496 ROSEMARY LN
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City | BRIGHTON
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State | MI
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Zip | 48114-7542
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Country | US
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Telephone | 810-209-8882
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Fax | 949-862-8090
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Provider Business Mailing Address
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Address Line | 9496 ROSEMARY LN
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City | BRIGHTON
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State | MI
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Zip | 48114-7542
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Country | US
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Telephone | 810-209-8882
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Fax | 949-862-8090
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO2768
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OT017953
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 5101026490
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License Number State | MI
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