Provider Demographics
NPI:1013542968
Name:GUERRA, TIFFANY RENE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENE
Last Name:GUERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S MESA HILLS DR APT 1086
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5476
Mailing Address - Country:US
Mailing Address - Phone:210-739-8877
Mailing Address - Fax:
Practice Address - Street 1:5001 EL PASO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2827
Practice Address - Country:US
Practice Address - Phone:915-215-5635
Practice Address - Fax:915-783-5139
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program