Healthcare Provider Details

I. General information

NPI: 1922488592
Provider Name (Legal Business Name): ANNETTE GUERRA LSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE BUITRAGO CFSA

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 866-974-2673
  • Fax: 866-939-2673
Mailing address:
  • Phone: 866-974-2673
  • Fax: 866-939-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA000587
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number157449
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: