Provider Demographics
NPI:1780252270
Name:SEVERO-GUEVARRA, CHARMAINE ORINO
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:ORINO
Last Name:SEVERO-GUEVARRA
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 1:6851 SAN RAFAEL CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5064
Mailing Address - Country:US
Mailing Address - Phone:805-453-8710
Mailing Address - Fax:
Practice Address - Street 1:6851 SAN RAFAEL CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5064
Practice Address - Country:US
Practice Address - Phone:805-453-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily