Provider Demographics
NPI:1700393378
Name:GUERRA, AMMY C
Entity Type:Individual
Prefix:
First Name:AMMY
Middle Name:C
Last Name:GUERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78900 AVENUE 47
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2070
Mailing Address - Country:US
Mailing Address - Phone:760-625-0951
Mailing Address - Fax:
Practice Address - Street 1:78900 AVENUE 47
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2070
Practice Address - Country:US
Practice Address - Phone:760-625-0951
Practice Address - Fax:760-564-5049
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician