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General NPI Number Information
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NPI Number | 1205319019
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Entity Type | Individual
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Provider Name | LUPE GUERRA JR.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2018
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 2971 PEARSON JAMES PL
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City | LUTZ
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State | FL
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Zip | 33559-6996
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Country | US
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Telephone | 813-388-2347
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Fax | 813-345-8999
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Provider Business Mailing Address
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Address Line | 7765 BRIAN LOOP
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City | LAKELAND
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State | FL
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Zip | 33810-5137
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9110992
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License Number State | FL
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