Provider Demographics
NPI:1760065585
Name:GUERRA, LATESA ADELE (DC)
Entity Type:Individual
Prefix:DR
First Name:LATESA
Middle Name:ADELE
Last Name:GUERRA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 WAPITI RD
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2089
Mailing Address - Country:US
Mailing Address - Phone:713-398-8476
Mailing Address - Fax:
Practice Address - Street 1:9600 ESCARPMENT BLVD STE 930
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1986
Practice Address - Country:US
Practice Address - Phone:512-859-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor