Healthcare Provider Details

I. General information

NPI: 1194734392
Provider Name (Legal Business Name): ELVIRA GUERRERO SOMERA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 123
FPO AE
09617
IT

IV. Provider business mailing address

PSC 827 BOX 123
FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 81-629-5603
  • Fax:
Mailing address:
  • Phone: 81-629-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number359493-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: