Provider Demographics
NPI:1578537817
Name:GUERRA, ALEXIS S (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:S
Last Name:GUERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 W 49 ST
Mailing Address - Street 2:SUITE 516
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012
Mailing Address - Country:US
Mailing Address - Phone:305-269-6900
Mailing Address - Fax:305-558-9812
Practice Address - Street 1:1840 W 49 ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-269-6900
Practice Address - Fax:305-558-9812
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08176EMedicare ID - Type Unspecified