Provider Demographics
NPI:1366751281
Name:GUEVARA, NUBIA ESPERANZA (PT)
Entity type:Individual
Prefix:MRS
First Name:NUBIA
Middle Name:ESPERANZA
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 NE 117TH ST
Mailing Address - Street 2:
Mailing Address - City:BISCAYNE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6752
Mailing Address - Country:US
Mailing Address - Phone:305-891-1667
Mailing Address - Fax:
Practice Address - Street 1:5190 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2476
Practice Address - Country:US
Practice Address - Phone:305-448-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888731400Medicaid