Provider Demographics
NPI:1235155318
Name:GUERRERO, ETHELWOLDO PASCUAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHELWOLDO
Middle Name:PASCUAL
Last Name: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 1:550 W RANCH VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5396
Mailing Address - Country:US
Mailing Address - Phone:916-295-5700
Mailing Address - Fax:
Practice Address - Street 1:151 E WEBSTER ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2949
Practice Address - Country:US
Practice Address - Phone:530-458-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A6153900Medicaid
CAZZZ01171ZMedicare ID - Type Unspecified
CA00A615391Medicare PIN