Healthcare Provider Details

I. General information

NPI: 1487666996
Provider Name (Legal Business Name): JOSEFINA GUERRERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR BLDG B203
RANCHO MIRAGE CA
92270-4126
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR BLDG B203
RANCHO MIRAGE CA
92270-4126
US

V. Phone/Fax

Practice location:
  • Phone: 760-674-3847
  • Fax:
Mailing address:
  • Phone: 760-674-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA41364
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA41364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: