Healthcare Provider Details

I. General information

NPI: 1679528897
Provider Name (Legal Business Name): BILLIE YVONNE GUERRA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BILLIE YVONNE THOMAS

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

IV. Provider business mailing address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-3640
  • Fax: 760-499-7229
Mailing address:
  • Phone: 760-499-3855
  • Fax: 760-499-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A8965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: