Provider Demographics
NPI:1720381759
Name:NESTOR M. GUERRERO, M.D., P.A.
Entity Type:Organization
Organization Name:NESTOR M. GUERRERO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-521-3266
Mailing Address - Street 1:37740 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4221
Mailing Address - Country:US
Mailing Address - Phone:352-521-3266
Mailing Address - Fax:352-521-3267
Practice Address - Street 1:37740 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4221
Practice Address - Country:US
Practice Address - Phone:352-521-3266
Practice Address - Fax:352-521-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43778208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046516000Medicaid
FLER302AMedicare PIN