MEDICARE: DR. LUIS F. GUEVARA PSY.D.

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	103T00000X	Psychologist	PY0510	NV
2	103T00000X	Psychologist	PSY 17964	CA

General Provider Information

NPI Number	:	1760782734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS F. GUEVARA PSY.D.

Provider Business Mailing Address
First Line	:	7351 W CHARLESTON BLVD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1572
Country	:	US
Telephone Number	:	702-360-4836
Fax Number	:	702-946-0866

Provider Business Practice Location Address
First Line	:	7351 W CHARLESTON BLVD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1572
Country	:	US
Telephone Number	:	702-360-4836
Fax Number	:	702-946-0866

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

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	10/25/2010

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