MEDICARE: MR. RODRIGO 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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	40223	TX

General Provider Information

NPI Number	:	1396446225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RODRIGO GUERRERO

Provider Business Mailing Address
First Line	:	2343 PENDANT PASS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5604
Country	:	US
Telephone Number	:	210-427-9419
Fax Number	:

Provider Business Practice Location Address
First Line	:	2343 PENDANT PASS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5604
Country	:	US
Telephone Number	:	210-427-9419
Fax Number	:

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

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	09/12/2024

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