Healthcare Provider Details

I. General information

NPI: 1417363649
Provider Name (Legal Business Name): JOSE GUERRA, D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16371 ACE LN
HUNTINGTON BEACH CA
92649-2701
US

IV. Provider business mailing address

16371 ACE LN
HUNTINGTON BEACH CA
92649-2701
US

V. Phone/Fax

Practice location:
  • Phone: 714-585-2563
  • Fax:
Mailing address:
  • Phone: 714-585-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number8135
License Number StateCA

VIII. Authorized Official

Name: JOSE GUERRA
Title or Position: OWNER
Credential: D.O.
Phone: 714-585-2563