Provider Demographics
NPI:1518112382
Name:RICHARD A GUERRERO JR MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD A GUERRERO JR MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:714-617-4733
Mailing Address - Street 1:5267 WARNER AVE
Mailing Address - Street 2:#322
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4079
Mailing Address - Country:US
Mailing Address - Phone:714-617-4733
Mailing Address - Fax:714-617-4748
Practice Address - Street 1:11100 WARNER AVE STE 266
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7512
Practice Address - Country:US
Practice Address - Phone:714-617-4733
Practice Address - Fax:714-617-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79327208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty