Basic Information
Provider Information
NPI: 1003154808
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUEVARRA
FirstName: VERONICA
MiddleName: CABAL
NamePrefix:  
NameSuffix:  
Credential: RDHAP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 34765 DORADO LN
Address2:  
City: MURRIETA
State: CA
PostalCode: 925638439
CountryCode: US
TelephoneNumber: 6199299235
FaxNumber: 2089883126
Practice Location
Address1: 34765 DORADO LN
Address2:  
City: MURRIETA
State: CA
PostalCode: 925638439
CountryCode: US
TelephoneNumber: 6199299235
FaxNumber: 2089883126
Other Information
ProviderEnumerationDate: 01/29/2013
LastUpdateDate: 09/24/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000X455CAY Dental ProvidersDental Hygienist 
124Q00000X24861CAN Dental ProvidersDental Hygienist 

No ID Information.


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