Healthcare Provider Details

I. General information

NPI: 1396170379
Provider Name (Legal Business Name): HEATHER IRENE GUERRA AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 E BASELINE RD STE 126
MESA AZ
85206-4673
US

IV. Provider business mailing address

6262 E BROADWAY RD STE 103
MESA AZ
85206-6101
US

V. Phone/Fax

Practice location:
  • Phone: 480-265-8067
  • Fax:
Mailing address:
  • Phone: 480-830-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA8536
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA8536
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: