Provider Demographics
NPI:1790384246
Name:GUERRERO, PAUL MARTIN T III
Entity Type:Individual
Prefix:
First Name:PAUL MARTIN
Middle Name:T
Last Name:GUERRERO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 DUNSHEE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2026
Mailing Address - Country:US
Mailing Address - Phone:702-768-3594
Mailing Address - Fax:
Practice Address - Street 1:5505 DUNSHEE VISTA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2026
Practice Address - Country:US
Practice Address - Phone:702-768-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV819413163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA