Provider Demographics
NPI:1457323644
Name:GUERRA, ANGEL AURELIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:AURELIO
Last Name:GUERRA
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 1:11365 NW 7TH ST
Mailing Address - Street 2:APT: 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3583
Mailing Address - Country:US
Mailing Address - Phone:786-382-7312
Mailing Address - Fax:
Practice Address - Street 1:9301 NW 33RD ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1202
Practice Address - Country:US
Practice Address - Phone:305-437-1353
Practice Address - Fax:305-437-2910
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000541800Medicaid
FLBN926ZMedicare PIN