Healthcare Provider Details

I. General information

NPI: 1346492758
Provider Name (Legal Business Name): ANGEL A GUERRA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 SW 8TH ST SUITE 23 B
MIAMI FL
33174-2900
US

IV. Provider business mailing address

11365 NW 7TH ST APT 204
MIAMI FL
33172-3583
US

V. Phone/Fax

Practice location:
  • Phone: 786-382-7312
  • Fax: 305-228-9628
Mailing address:
  • Phone: 786-382-7312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME96982
License Number StateFL

VIII. Authorized Official

Name: ANGEL A GUERRA
Title or Position: PRESIDENT
Credential: MD
Phone: 786-382-7312