Healthcare Provider Details

I. General information

NPI: 1821903329
Provider Name (Legal Business Name): AZRIEL GUERRA CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST
GULFPORT MS
39501-2515
US

IV. Provider business mailing address

4216 SCOVEL AVE
PASCAGOULA MS
39581-2935
US

V. Phone/Fax

Practice location:
  • Phone: 228-867-4000
  • Fax:
Mailing address:
  • Phone: 228-712-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number6303
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: