Healthcare Provider Details

I. General information

NPI: 1194072777
Provider Name (Legal Business Name): SARA M GUERRA MD, FRCSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8436 W 3RD ST STE 800
LOS ANGELES CA
90048-4100
US

IV. Provider business mailing address

8436 W 3RD ST STE 800
LOS ANGELES CA
90048-4100
US

V. Phone/Fax

Practice location:
  • Phone: 310-860-3048
  • Fax: 310-550-7680
Mailing address:
  • Phone: 310-860-3048
  • Fax: 310-550-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA145873
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA145873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: