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General NPI Number Information
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NPI Number | 1689828261
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Entity Type | Individual
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Provider Name | ANGELA GUERRA L.A.C.
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Gender | Female
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 705 VILLAGE GREEN WAY SUITE 105
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City | WEST BEND
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State | WI
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Zip | 53090-2527
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Country | US
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Telephone | 262-685-7661
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Fax |
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Provider Business Mailing Address
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Address Line | 235 S 11TH AVE
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City | WEST BEND
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State | WI
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Zip | 53095-3112
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Country | US
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Telephone | 262-685-7661
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Fax | 262-334-4078
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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 | 537-055
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License Number State | WI
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