Provider Demographics
NPI:1124425491
Name:GUERRERO, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GUERRERO
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 1:2708 W MEADOWWOOD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5433
Mailing Address - Country:US
Mailing Address - Phone:714-323-6021
Mailing Address - Fax:
Practice Address - Street 1:2708 W MEADOWWOOD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5433
Practice Address - Country:US
Practice Address - Phone:714-323-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10272225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant