Healthcare Provider Details

I. General information

NPI: 1386519528
Provider Name (Legal Business Name): JUSTIN REY GUERRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 MEDICAL DR STE 100
SAN ANTONIO TX
78229-2292
US

IV. Provider business mailing address

9590 CAMPTON FARMS
SAN ANTONIO TX
78250-1716
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-6120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1070993
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: