Healthcare Provider Details

I. General information

NPI: 1598224982
Provider Name (Legal Business Name): GERARDO GUERRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

V. Phone/Fax

Practice location:
  • Phone: 562-458-4035
  • Fax:
Mailing address:
  • Phone: 951-788-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA176413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: