Provider Demographics
NPI:1437425071
Name:ALEXIS S GUERRA MD PA
Entity Type:Organization
Organization Name:ALEXIS S GUERRA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-818-3503
Mailing Address - Street 1:1435 W 49TH PL
Mailing Address - Street 2:SUITE 703
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3197
Mailing Address - Country:US
Mailing Address - Phone:305-818-3503
Mailing Address - Fax:305-822-9333
Practice Address - Street 1:1435 W 49TH PL
Practice Address - Street 2:SUITE 703
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3197
Practice Address - Country:US
Practice Address - Phone:305-818-3503
Practice Address - Fax:305-822-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME54746OtherCOMMERCIAL INSURANCES