Healthcare Provider Details

I. General information

NPI: 1942117965
Provider Name (Legal Business Name): KLARISSA MONIQUE GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82076 SOLANO AVE
INDIO CA
92201-6815
US

IV. Provider business mailing address

82076 SOLANO AVE
INDIO CA
92201-6815
US

V. Phone/Fax

Practice location:
  • Phone: 760-600-3853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: