Provider Demographics
NPI:1003640657
Name:GUERRA LI, JOSE L
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:GUERRA LI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10513 WEEPING WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5125
Mailing Address - Country:US
Mailing Address - Phone:813-451-5225
Mailing Address - Fax:
Practice Address - Street 1:10513 WEEPING WILLOW PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5125
Practice Address - Country:US
Practice Address - Phone:813-451-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-75199103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst