Provider Demographics
NPI:1609204395
Name:GUERRA ORELLANA, JOSE RODOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RODOLFO
Last Name:GUERRA ORELLANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:RODOLFO
Other - Last Name:GUERRA-ORELLANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:408 CREPE MYRTLE DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-7404
Practice Address - Country:US
Practice Address - Phone:864-230-3823
Practice Address - Fax:833-645-0923
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-03909207R00000X
VA0101270170207R00000X
SC38930207R00000X
FLME120980207R00000X
CODR.0064918207R00000X
ARE-8779207R00000X
FLTELEHEALTH-828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine