Healthcare Provider Details

I. General information

NPI: 1669377859
Provider Name (Legal Business Name): LILIAN GUERRA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2023 KAIOLI ST APT 3404
EWA BEACH HI
96706-6147
US

IV. Provider business mailing address

91-2023 KAIOLI ST APT 3404
EWA BEACH HI
96706-6147
US

V. Phone/Fax

Practice location:
  • Phone: 210-419-1790
  • Fax:
Mailing address:
  • Phone: 210-419-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN-6072
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: