Healthcare Provider Details

I. General information

NPI: 1124431218
Provider Name (Legal Business Name): GERARDO GUERRERO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SW 137TH AVE SUITE 116
MIAMI FL
33186-1411
US

IV. Provider business mailing address

9000 SW 137TH AVE SUITE 116
MIAMI FL
33186-1411
US

V. Phone/Fax

Practice location:
  • Phone: 305-382-9550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT 29194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: