Provider Demographics
NPI:1588828669
Name:GUERRERO, JESSE PHILIPPE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:PHILIPPE
Last Name:GUERRERO
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 1:730 GRAVITY WAY
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-9425
Mailing Address - Country:US
Mailing Address - Phone:425-495-1591
Mailing Address - Fax:425-427-6033
Practice Address - Street 1:660 NW GILMAN BLVD
Practice Address - Street 2:#C6
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2421
Practice Address - Country:US
Practice Address - Phone:425-427-0038
Practice Address - Fax:425-427-0613
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist