=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053677526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA A GUERRERO PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2012
-----------------------------------------------------
Last Update Date | 04/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14094 LA SALLE COURT
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-827-1878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14094 LA SALLE CT
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92336-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-809-3110
-----------------------------------------------------
Fax | 909-809-3101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 48583
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------