Healthcare Provider Details

I. General information

NPI: 1225512544
Provider Name (Legal Business Name): FERNANDO DAVID GUERRERO MONTIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5849 CROCKER ST
LOS ANGELES CA
90003-1311
US

IV. Provider business mailing address

5849 CROCKER ST
LOS ANGELES CA
90003-1311
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-4445
  • Fax:
Mailing address:
  • Phone: 323-234-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: