Provider Demographics
NPI:1558807560
Name:GUERRA, JOSE (ESE)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GUERRA
Suffix:
Gender:M
Credentials:ESE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 SW 8ST, B-209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135
Mailing Address - Country:US
Mailing Address - Phone:786-340-1169
Mailing Address - Fax:
Practice Address - Street 1:3170 SW 8TH ST LOT B209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4565
Practice Address - Country:US
Practice Address - Phone:786-340-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker