Provider Demographics
NPI:1306022587
Name:LUIS G GUERRA DELAFUENTE MD,.PA,FACP
Entity Type:Organization
Organization Name:LUIS G GUERRA DELAFUENTE MD,.PA,FACP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD., PA., FACP
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:GUERRA DE LA FUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA,FACP
Authorized Official - Phone:915-771-8444
Mailing Address - Street 1:1900 N OREGON ST
Mailing Address - Street 2:STE 600
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3351
Mailing Address - Country:US
Mailing Address - Phone:915-771-8444
Mailing Address - Fax:915-771-8478
Practice Address - Street 1:1900 N OREGON ST
Practice Address - Street 2:STE 600
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3351
Practice Address - Country:US
Practice Address - Phone:915-771-8444
Practice Address - Fax:915-771-8478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123562401Medicaid
TX00Y496Medicare PIN