Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 25MA04812300 | NJ |
NPI | 1003867177 |
---|---|
Provider Name | Dr. Jesusita Herco Guevarra |
First Address | Moorestown, NJ 08057-3259 |
Second Address | Moorestown, NJ 08057-3238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 31/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7002301 | (05) | NJ |