Provider Demographics
NPI:1972581080
Name:GUERRERO, RENE A (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:A
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 NORTHRISE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-6839
Mailing Address - Country:US
Mailing Address - Phone:575-382-2149
Mailing Address - Fax:575-382-2187
Practice Address - Street 1:3485 NORTHRISE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-6839
Practice Address - Country:US
Practice Address - Phone:575-382-2149
Practice Address - Fax:575-382-2187
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-39207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00010520Medicaid
NMNMA102613Medicare PIN
NMNM 251-000Medicare ID - Type Unspecified