Provider Demographics
NPI:1487829198
Name:GUERRERO, PAUL (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 ESCONDIDO AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6160
Mailing Address - Country:US
Mailing Address - Phone:760-630-6013
Mailing Address - Fax:760-630-6088
Practice Address - Street 1:707 ESCONDIDO AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6160
Practice Address - Country:US
Practice Address - Phone:760-630-6013
Practice Address - Fax:760-630-6088
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 21340111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
U51355Medicare UPIN