Provider Demographics
NPI:1851379648
Name:GUERRERO-COTTRELL, TERESITA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:R
Last Name:GUERRERO-COTTRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4318
Mailing Address - Country:US
Mailing Address - Phone:951-658-0052
Mailing Address - Fax:951-658-1774
Practice Address - Street 1:409 E KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4318
Practice Address - Country:US
Practice Address - Phone:951-658-0052
Practice Address - Fax:951-658-1774
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12046103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL120460Medicare ID - Type Unspecified