Provider Demographics
NPI:1457674558
Name:GUERRERO, JESSE IGNACIO
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:IGNACIO
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JESSE
Other - Middle Name:IGNACIO
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3659 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-2119
Mailing Address - Country:US
Mailing Address - Phone:323-537-4107
Mailing Address - Fax:
Practice Address - Street 1:3659 54TH ST. LOMA VISTA AVE.
Practice Address - Street 2:HOUSE
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-2119
Practice Address - Country:US
Practice Address - Phone:323-537-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2425243126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant