Provider Demographics
NPI:1083965255
Name:GUERRERO, JUSTINE MICHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:MICHELLE
Last Name:GUERRERO
Suffix:
Gender:F
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 1:1803 HORSETAIL FLS APT 1
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2476
Mailing Address - Country:US
Mailing Address - Phone:956-607-1900
Mailing Address - Fax:
Practice Address - Street 1:901 WILSON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2439
Practice Address - Country:US
Practice Address - Phone:337-456-6523
Practice Address - Fax:337-456-6521
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14984363A00000X
LA329480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant