Provider Demographics
NPI:1922303593
Name:GUERRERO, GRACE ALCANTARA (PT)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ALCANTARA
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ESTANDARTE
Other - Last Name:ALCANTARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1645 ORINDA CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2932
Mailing Address - Country:US
Mailing Address - Phone:619-781-7555
Mailing Address - Fax:
Practice Address - Street 1:8787 CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3034
Practice Address - Country:US
Practice Address - Phone:619-460-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist