Provider Demographics
NPI:1346396645
Name:GUERRA, JOSE J (DO)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:GUERRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16371 ACE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2701
Mailing Address - Country:US
Mailing Address - Phone:714-362-0826
Mailing Address - Fax:
Practice Address - Street 1:1720 W BALL RD STE 3B
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5586
Practice Address - Country:US
Practice Address - Phone:714-772-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine