Provider Demographics
NPI:1184689671
Name:LEON GUERRERO, RANDOLPH FLORES (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:FLORES
Last Name:LEON GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VAPIHCS
Mailing Address - Street 2:459 PATTERSON RD.
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:626-403-7563
Mailing Address - Fax:
Practice Address - Street 1:VAPIHCS
Practice Address - Street 2:459 PATTERSON RD.
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:626-403-7563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine