Healthcare Provider Details

I. General information

NPI: 1639707268
Provider Name (Legal Business Name): NICOLE ALICIA GUERRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S BUILDING 6//SUITE B125
BRONX NY
10461-1138
US

IV. Provider business mailing address

1400 PELHAM PKWY S BUILDING 6//SUITE B125
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5820
  • Fax:
Mailing address:
  • Phone: 718-918-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number328436
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: