Provider Demographics
NPI:1386192243
Name:GUERRERO MORENO, RAQUEL (DDS)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:
Last Name:GUERRERO MORENO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.P.S. 4275 EXECUTIVE SQUARE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LERDO 1515 4 ENTRE G Y CALLE H
Practice Address - Street 2:NVEVA MEXICALI
Practice Address - City:MEXICALI
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21100
Practice Address - Country:MX
Practice Address - Phone:01152686-552-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ4685921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist