Provider Demographics
NPI:1922810605
Name:GUERRA, EVELIN
Entity type:Individual
Prefix:
First Name:EVELIN
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 E 44TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1821
Mailing Address - Country:US
Mailing Address - Phone:786-262-3530
Mailing Address - Fax:
Practice Address - Street 1:3350 SW 148TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3237
Practice Address - Country:US
Practice Address - Phone:786-346-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-24-15741106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst