Provider Demographics
NPI:1528425865
Name:GUEVARA, ILIANA
Entity type:Individual
Prefix:
First Name:ILIANA
Middle Name:
Last Name:GUEVARA
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 1:1600 N OREGON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3594
Mailing Address - Country:US
Mailing Address - Phone:915-532-2445
Mailing Address - Fax:915-532-2509
Practice Address - Street 1:1600 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3594
Practice Address - Country:US
Practice Address - Phone:915-532-2445
Practice Address - Fax:915-532-2509
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX757460163W00000X
TXAP129682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse