Healthcare Provider Details

I. General information

NPI: 1104029735
Provider Name (Legal Business Name): ADRIANA GUERRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANA LE M.D.

II. Dates (important events)

Enumeration Date: 06/10/2007
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W. NORTH LOOP BLVD.
AUSTIN TX
78756
US

IV. Provider business mailing address

2301 W. NORTH LOOP BLVD.
AUSTIN TX
78756
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-2506
  • Fax: 512-824-0152
Mailing address:
  • Phone: 512-452-2506
  • Fax: 512-824-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.117278
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN3132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: