Mirene Guevarra

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95018158 Issued in CA

Practice address

425 Diamond Dr
Lake Elsinore, CA 92530-4495

Phone

(951) 674-4114

NPI assigned

Aug 20, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Healthcare Partners Affiliates Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659312593
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630108800000",
    "number": "1649946302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 DIAMOND DR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304495",
            "telephone_number": "951-674-4114",
            "fax_number": "951-674-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 DIAMOND DR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304495",
            "telephone_number": "951-674-4114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUEVARRA",
        "first_name": "MIRENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-20",
        "last_updated": "2021-08-28",
        "certification_date": "2021-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95018158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Noelle Grieger, P.T.
• Jonathan Paul Grimm
• Rikki Reane Grisso, LVN
• Paula Guadron, B.S. (PSYCHOLOGY)
• Tonia Guerin
• Guiding Hearts Behavioral Services
• Claudia Gisela Guillen-Medrano
• Marco Guillen, C.A.S.
• Vreige Sarkis Gulgulian Jr.
• Alison Gunby, DPT

• Family Nurse Practitioner in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.