Healthcare Provider Details

I. General information

NPI: 1467939512
Provider Name (Legal Business Name): MIGUEL ANGEL OQUENDO GUERRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 WESTCHESTER AVE STE 401
PURCHASE NY
10577-2524
US

IV. Provider business mailing address

8 PLAINVIEW CT
CONGERS NY
10920-2611
US

V. Phone/Fax

Practice location:
  • Phone: 888-660-3494
  • Fax:
Mailing address:
  • Phone: 347-283-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number311896-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: