Provider Demographics
NPI:1518538073
Name:GUERRA TORO, JOSE DANIEL
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:DANIEL
Last Name:GUERRA TORO
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 1:3334 ROCHESTER RD
Mailing Address - Street 2:PMB 230
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5426
Mailing Address - Country:US
Mailing Address - Phone:586-525-1497
Mailing Address - Fax:
Practice Address - Street 1:22250 PROVIDENCE DRIVE
Practice Address - Street 2:7PMB SUITE #703A
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-5862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351048130208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery