Provider Demographics
NPI:1235700980
Name:GUERRA LOPEZ, ALBERTO
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:GUERRA LOPEZ
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 1:7328 ETIWANDA AVE
Mailing Address - Street 2:N/A
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335
Mailing Address - Country:US
Mailing Address - Phone:323-206-1018
Mailing Address - Fax:
Practice Address - Street 1:5554 RESEDA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6212
Practice Address - Country:US
Practice Address - Phone:818-705-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer