MEDICARE: MARY JANE GUERRERO NP

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	363LF0000X	Family Nurse Practitioner	95001379	CA
2	163W00000X	Registered Nurse	685076	CA

General Provider Information

NPI Number	:	1316484793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JANE GUERRERO NP

Provider Business Mailing Address
First Line	:	11257 RUDMAN DR
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-5503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11257 RUDMAN DR
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-5503
Country	:	US
Telephone Number	:	714-318-4579
Fax Number	:

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

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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