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General NPI Number Information
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NPI Number | 1326478678
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Entity Type | Individual
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Provider Name | JESSICA LEANN GUERRA AP, DOM
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Gender | Female
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Dates
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Enumeration Date | 11/23/2013
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Last Update Date | 11/23/2013
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Provider Practice Location Address
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Address Line | 21234 OLEAN BLVD UNIT 4
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6752
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Country | US
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Telephone | 941-626-1992
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Fax |
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Provider Business Mailing Address
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Address Line | 21234 OLEAN BLVD UNIT 4
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6752
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Country | US
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Telephone | 941-626-1992
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP3313
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License Number State | FL
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