=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700071420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VICTOR M GUERRERO MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2007
-----------------------------------------------------
Last Update Date | 09/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1145 E CLARK AVE SUITE C
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93455-5151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-937-8560
-----------------------------------------------------
Fax | 805-937-0965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1145 E CLARK AVE SUITE C
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93455-5151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-937-8560
-----------------------------------------------------
Fax | 805-937-0965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VICTOR M GUERRERO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-937-8560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A50302
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------