Provider Demographics
NPI:1760848667
Name:GUERRA BAZAN, MANUEL D (APRN)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:D
Last Name:GUERRA BAZAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 RANKIN RD # B4
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-4602
Mailing Address - Country:US
Mailing Address - Phone:832-827-2726
Mailing Address - Fax:832-827-2716
Practice Address - Street 1:802 RANKIN RD STE B4
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-4602
Practice Address - Country:US
Practice Address - Phone:832-827-2726
Practice Address - Fax:832-827-2716
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
TX1034787163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No163W00000XNursing Service ProvidersRegistered Nurse