Provider Demographics
NPI:1215586136
Name:GUERRERO, MOISES E
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:E
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 ALTA DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3940
Mailing Address - Country:US
Mailing Address - Phone:702-685-3418
Mailing Address - Fax:702-947-4688
Practice Address - Street 1:5020 ALTA DR STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3940
Practice Address - Country:US
Practice Address - Phone:702-685-3418
Practice Address - Fax:702-947-4688
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant