MEDICARE: IVET MARGARITA 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	252Y00000X	Early Intervention Provider Agency		FL

General Provider Information

NPI Number	:	1902439128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVET MARGARITA GUEVARA

Provider Business Mailing Address
First Line	:	7925 SW 26TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-2528
Country	:	US
Telephone Number	:	305-297-0818
Fax Number	:

Provider Business Practice Location Address
First Line	:	7925 SW 26TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-2528
Country	:	US
Telephone Number	:	305-297-0818
Fax Number	:

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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