MEDICARE: JULYSSA GUEVARA

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	1041C0700X	Clinical Social Worker	73294	CA

General Provider Information

NPI Number	:	1811449606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULYSSA GUEVARA

Provider Business Mailing Address
First Line	:	3624 W 36TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4814
Country	:	US
Telephone Number	:	323-309-7031
Fax Number	:

Provider Business Practice Location Address
First Line	:	3624 W 36TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4814
Country	:	US
Telephone Number	:	323-309-7031
Fax Number	:

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

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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Directions to “ JULYSSA GUEVARA ” Practice Location

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