Healthcare Provider Details

I. General information

NPI: 1710283353
Provider Name (Legal Business Name): EFRAIN A GUERRERO R.N.N.P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2011
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 PINE AVE
HOLTVILLE CA
92250-1121
US

IV. Provider business mailing address

1530 S IMPERIAL AVE
EL CENTRO CA
92243-4241
US

V. Phone/Fax

Practice location:
  • Phone: 760-356-5568
  • Fax: 760-356-5566
Mailing address:
  • Phone: 760-337-1025
  • Fax: 760-336-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN246188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: