Provider Demographics
NPI:1437708518
Name:GUERRA, BRENDAN DOMINGO
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:DOMINGO
Last Name:GUERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5617 VISTA SAN JUANICO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-5672
Mailing Address - Country:US
Mailing Address - Phone:619-204-4905
Mailing Address - Fax:
Practice Address - Street 1:5617 VISTA SAN JUANICO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-5672
Practice Address - Country:US
Practice Address - Phone:619-204-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator