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General NPI Number Information
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NPI Number | 1780003459
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Entity Type | Individual
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Provider Name | JADE GIESEKE GUEVARA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 601 N FLAMINGO RD STE 215
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1015
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Country | US
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Telephone | 954-452-9922
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Fax | 352-265-1107
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Provider Business Mailing Address
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Address Line | 2046 E SAMPLE RD
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33064-7596
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Country | US
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Telephone | 954-994-2020
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Fax | 994-994-0017
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME136354
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License Number State | FL
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