Provider Demographics
NPI:1346635125
Name:GUERRERO, EVAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:MICHAEL
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 1:26401 CROWN VALLEY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6302
Mailing Address - Country:US
Mailing Address - Phone:949-348-4000
Mailing Address - Fax:949-348-7466
Practice Address - Street 1:26401 CROWN VALLEY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6302
Practice Address - Country:US
Practice Address - Phone:949-348-4020
Practice Address - Fax:949-348-7466
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-01251207X00000X
CA173015207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0397730007OtherNSC#