MEDICARE: STEPHANIE T. GUEVARA MAED

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	171M00000X	Case Manager/Care Coordinator		CA

General Provider Information

NPI Number	:	1578838496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE T. GUEVARA MAED

Provider Business Mailing Address
First Line	:	10221 COMPTON AVE STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90002-2805
Country	:	US
Telephone Number	:	310-783-4677
Fax Number	:	323-566-1638

Provider Business Practice Location Address
First Line	:	10221 COMPTON AVE STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90002-2805
Country	:	US
Telephone Number	:	310-783-4677
Fax Number	:	323-566-1638

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

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	07/25/2016

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