Healthcare Provider Details

I. General information

NPI: 1437070356
Provider Name (Legal Business Name): KEVIN GUERRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W PACIFIC COAST HWY STE 1
LONG BEACH CA
90806-5237
US

IV. Provider business mailing address

1435 E 75TH ST
LOS ANGELES CA
90001-3067
US

V. Phone/Fax

Practice location:
  • Phone: 562-432-0713
  • Fax:
Mailing address:
  • Phone: 310-679-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: