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General NPI Number Information
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NPI Number | 1427658376
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Entity Type | Individual
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Provider Name | RAEANNE CLEMENS GUERRA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 14114 BUSINESS CENTER DR STE A
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City | MORENO VALLEY
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State | CA
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Zip | 92553-9113
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Country | US
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Telephone | 951-697-4133
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Fax |
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Provider Business Mailing Address
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Address Line | 7450 NORTHROP DR APT 363
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City | RIVERSIDE
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State | CA
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Zip | 92508-5013
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Country | US
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Telephone | 253-217-1769
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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 | 58608
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License Number State | CA
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