Provider Demographics
NPI:1013201359
Name:GUERRERO-PEZZANO, TATYANA (MD)
Entity Type:Individual
Prefix:MS
First Name:TATYANA
Middle Name:
Last Name:GUERRERO-PEZZANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 GONZALES RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-2401
Mailing Address - Country:US
Mailing Address - Phone:505-831-2534
Mailing Address - Fax:
Practice Address - Street 1:6900 GONZALES RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2401
Practice Address - Country:US
Practice Address - Phone:505-831-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine