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General NPI Number Information
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NPI Number | 1386192243
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Entity Type | Individual
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Provider Name | RAQUEL GUERRERO MORENO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | LERDO 1515 4 ENTRE G Y CALLE H NVEVA MEXICALI
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City | MEXICALI
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State | BAJA CALIFORNIA
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Zip | 21100
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Country | MX
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Telephone | 011526865522906
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Fax |
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Provider Business Mailing Address
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Address Line | P.P.S. 4275 EXECUTIVE SQUARE STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92037
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4685921
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License Number State | ZZ
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