MEDICARE: AMOS JOAQUIN GUERRERO

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1376840660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMOS JOAQUIN GUERRERO

Provider Business Mailing Address
First Line	:	1538 DINA CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1634
Country	:	US
Telephone Number	:	408-912-3384
Fax Number	:

Provider Business Practice Location Address
First Line	:	1538 DINA CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1634
Country	:	US
Telephone Number	:	408-912-3384
Fax Number	:

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

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	02/22/2011

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Directions to “ AMOS JOAQUIN GUERRERO ” Practice Location

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