Healthcare Provider Details

I. General information

NPI: 1891912911
Provider Name (Legal Business Name): JACQUELINE MARIE GUERRERO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S. MANCHESTER AVE SUITE 600
ORANGE CA
92868-3217
US

IV. Provider business mailing address

101 CITY DRIVE S. BUILDING 56 SUITE 800
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-2911
  • Fax: 714-456-8383
Mailing address:
  • Phone: 714-456-6853
  • Fax: 714-456-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA94381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: