Healthcare Provider Details

I. General information

NPI: 1942264353
Provider Name (Legal Business Name): SERGIO GUERRERA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WOODBURY RD
WATERTOWN CT
06795-2130
US

IV. Provider business mailing address

40 CHARTER OAK AVE
WATERBURY CT
06708-2804
US

V. Phone/Fax

Practice location:
  • Phone: 860-945-7927
  • Fax:
Mailing address:
  • Phone: 203-754-2802
  • Fax: 860-945-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: