Healthcare Provider Details

I. General information

NPI: 1073609418
Provider Name (Legal Business Name): LOURDES M GUERRERO-TIRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOURDES MALVEDA GUERRERO M.D.

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD MAIN BUILDING
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD BUILDING 2108, SUITE 101
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-3366
  • Fax: 602-933-4166
Mailing address:
  • Phone: 602-512-8029
  • Fax: 602-512-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number21095
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: