Healthcare Provider Details

I. General information

NPI: 1326881376
Provider Name (Legal Business Name): SAMUEL GUERRERO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W NORTHERN LIGHTS BLVD STE C3
ANCHORAGE AK
99503-3614
US

IV. Provider business mailing address

1350 W NORTHERN LIGHTS BLVD STE C3
ANCHORAGE AK
99503-3614
US

V. Phone/Fax

Practice location:
  • Phone: 907-334-8020
  • Fax: 907-334-8019
Mailing address:
  • Phone: 907-334-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number223365
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: