MEDICARE: DR. ETHELWOLDO PASCUAL GUERRERO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A61539	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235155318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETHELWOLDO PASCUAL GUERRERO MD

Provider Business Mailing Address
First Line	:	550 W RANCH VIEW DR
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-5396
Country	:	US
Telephone Number	:	916-295-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 E WEBSTER ST
Second Line	:
City	:	COLUSA
State	:	CA
Zip	:	95932-2949
Country	:	US
Telephone Number	:	530-458-4250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	09/23/2011

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