Provider Demographics
NPI:1891937249
Name:GUERRERO FERNANDES, ANDRE V (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:V
Last Name:GUERRERO FERNANDES
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 E FOOTHILL BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1333 E FOOTHILL BLVD STE 1
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4052
Practice Address - Country:US
Practice Address - Phone:909-982-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126757204E00000X, 204E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery