Provider Demographics
NPI:1033649454
Name:GUERRERO, LUIS GABRIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:GABRIEL
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14508 BELLE VILLA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-3492
Mailing Address - Country:US
Mailing Address - Phone:225-328-3120
Mailing Address - Fax:
Practice Address - Street 1:2840 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-2721
Practice Address - Country:US
Practice Address - Phone:225-224-2402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant