Provider Demographics
NPI:1942466495
Name:JOHN ROBERT GUERRA DO PA
Entity Type:Organization
Organization Name:JOHN ROBERT GUERRA DO PA
Other - Org Name:WOMAN'S PLACE AT THE LAKES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-686-3900
Mailing Address - Street 1:4304 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2477
Mailing Address - Country:US
Mailing Address - Phone:956-686-3900
Mailing Address - Fax:956-686-3323
Practice Address - Street 1:4304 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2477
Practice Address - Country:US
Practice Address - Phone:956-686-3900
Practice Address - Fax:956-686-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122362004Medicaid
TX122362004Medicaid