Healthcare Provider Details

I. General information

NPI: 1083965255
Provider Name (Legal Business Name): JUSTINE MICHELLE GUERRERO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WILSON ST
LAFAYETTE LA
70503-2439
US

IV. Provider business mailing address

1803 HORSETAIL FLS APT 1
EDINBURG TX
78539-2476
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-6523
  • Fax: 337-456-6521
Mailing address:
  • Phone: 956-607-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14984
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number329480
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: