MEDICARE: JUAN GUERRERO HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1497589287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN GUERRERO HERNANDEZ

Provider Business Mailing Address
First Line	:	6115 W COUNTY LINE RD
Second Line	:
City	:	BROWN DEER
State	:	WI
Zip	:	53223-1264
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6111 N TEUTONIA AVE # 137
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-3646
Country	:	US
Telephone Number	:	414-426-2508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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