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General NPI Number Information
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NPI Number | 1467684829
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Entity Type | Individual
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Provider Name | LUIS ALBERTO GUERRA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2009
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 9555 ROOSEVELT AVE
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City | JACKSON HTS
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State | NY
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Zip | 11372-8014
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Country | US
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Telephone | 718-478-7272
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Fax | 718-478-6455
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Provider Business Mailing Address
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Address Line | 9555 ROOSEVELT AVE
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City | JACKSON HTS
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State | NY
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Zip | 11372-8014
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Country | US
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Telephone | 718-478-7272
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Fax | 718-478-6455
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 109513-1
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License Number State | NY
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