Healthcare Provider Details

I. General information

NPI: 1285013847
Provider Name (Legal Business Name): MARIO E GUERRERO PANEQUE ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15141 SW 42ND ST
MIAMI FL
33185-3949
US

IV. Provider business mailing address

4353 NW 77TH AVE FL 3
MIAMI FL
33166-6736
US

V. Phone/Fax

Practice location:
  • Phone: 305-204-0333
  • Fax: 305-359-7546
Mailing address:
  • Phone: 305-204-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: