MEDICARE: MS. AURORA GUEVARRA ACADEMIA NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	505124	CA

General Provider Information

NPI Number	:	1336787167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AURORA GUEVARRA ACADEMIA NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6717 MISSION ST STE D
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94014-2069
Country	:	US
Telephone Number	:	650-285-2503
Fax Number	:	650-285-2504

Provider Business Practice Location Address
First Line	:	6717 MISSION ST STE D
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94014-2069
Country	:	US
Telephone Number	:	650-285-2503
Fax Number	:	650-285-2504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/11/2019

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