Healthcare Provider Details

I. General information

NPI: 1942780978
Provider Name (Legal Business Name): MR. RUBEN GUERRERO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 THE CITY DR S
ORANGE CA
92868-3205
US

IV. Provider business mailing address

7132 1/2 LUXOR STREET
DOWNEY CA
90241
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6363
  • Fax:
Mailing address:
  • Phone: 562-343-8711
  • 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: