Provider Demographics
NPI:1083861652
Name:GUERRISE, KIM (DOM)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:GUERRISE
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:GUERRISE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:347 E PALMETTO PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5015
Mailing Address - Country:US
Mailing Address - Phone:561-417-7552
Mailing Address - Fax:561-417-7553
Practice Address - Street 1:347 EAST PALMETTO PARK RD.
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-417-7552
Practice Address - Fax:561-417-7553
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP#1549171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist