Provider Demographics
NPI:1619863800
Name:GUEVARRA, EDGARDO A
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:A
Last Name:GUEVARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24333 ORCHARD LAKE RD STE F
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1976
Mailing Address - Country:US
Mailing Address - Phone:248-893-7023
Mailing Address - Fax:248-893-7095
Practice Address - Street 1:24333 ORCHARD LAKE RD STE F
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1976
Practice Address - Country:US
Practice Address - Phone:248-893-7023
Practice Address - Fax:248-893-7095
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker