Healthcare Provider Details

I. General information

NPI: 1265439806
Provider Name (Legal Business Name): ROBERTO ANDRES GUERRERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12959 PALMS WEST DRIVE SUITE 210
LOXAHATCHEE FL
33470-4940
US

IV. Provider business mailing address

12959 PALMS WEST DRIVE STE 210
LOXAHATCHEE FL
33470-4940
US

V. Phone/Fax

Practice location:
  • Phone: 561-795-3333
  • Fax: 561-795-3612
Mailing address:
  • Phone: 561-795-3333
  • Fax: 561-791-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME71612
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME71612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: