Provider Demographics
NPI:1174645998
Name:GUERRA, ILIANA (RDCSPLD)
Entity Type:Individual
Prefix:MISS
First Name:ILIANA
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:RDCSPLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-1910
Mailing Address - Country:US
Mailing Address - Phone:956-458-6156
Mailing Address - Fax:
Practice Address - Street 1:2302 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-1910
Practice Address - Country:US
Practice Address - Phone:956-458-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07323133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178789701Medicaid