MEDICARE: LARISSA ANTONIA 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	207V00000X	Obstetrics & Gynecology Physician	ME 121834	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952534547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA ANTONIA GUERRERO MD

Provider Business Mailing Address
First Line	:	1071 S SUN DR
Second Line	:	SUITE 1043
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2405
Country	:	US
Telephone Number	:	407-333-1616
Fax Number	:	407-333-1617

Provider Business Practice Location Address
First Line	:	1071 S SUN DR
Second Line	:	SUITE 1043
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2405
Country	:	US
Telephone Number	:	407-333-1616
Fax Number	:	407-333-1617

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

Provider Enumeration Date	:	08/28/2009
Last Update Date	:	06/29/2015

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