Healthcare Provider Details

I. General information

NPI: 1528972965
Provider Name (Legal Business Name): RYAN GUERRA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23832 ROCKFIELD BLVD STE 160
LAKE FOREST CA
92630-2820
US

IV. Provider business mailing address

23832 ROCKFIELD BLVD STE 160
LAKE FOREST CA
92630-2820
US

V. Phone/Fax

Practice location:
  • Phone: 949-465-9500
  • Fax: 949-465-9506
Mailing address:
  • Phone: 949-465-9500
  • Fax: 949-465-9506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: