Healthcare Provider Details

I. General information

NPI: 1124476817
Provider Name (Legal Business Name): JOSE GUERRA MD & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 SW 70TH ST APT 347
SOUTH MIAMI FL
33143
US

IV. Provider business mailing address

6001 SW 70TH ST APT 347
SOUTH MIAMI FL
33143-3426
US

V. Phone/Fax

Practice location:
  • Phone: 786-514-2450
  • Fax:
Mailing address:
  • Phone: 786-514-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME121917
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberME121917
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberME121917
License Number StateFL

VIII. Authorized Official

Name: JOSE ARMANDO GUERRA-VALENCIA
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 786-514-2450