Provider Demographics
NPI:1760617427
Name:GUERRERO, LUIS ALFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALFREDO
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8112 CENTRALIA CT STE 101
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3701
Mailing Address - Country:US
Mailing Address - Phone:352-251-2588
Mailing Address - Fax:352-995-2015
Practice Address - Street 1:8112 CENTRALIA CT STE 101
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3701
Practice Address - Country:US
Practice Address - Phone:352-251-2588
Practice Address - Fax:352-995-2015
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD0424982081S0010X
MDD00791222081S0010X
FLME1208012081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103119500Medicaid