Provider Demographics
NPI:1184169104
Name:ROBERTO GUERRA MD PA
Entity type:Organization
Organization Name:ROBERTO GUERRA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA DEL CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-588-9417
Mailing Address - Street 1:3565 SW 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2825
Mailing Address - Country:US
Mailing Address - Phone:305-960-7668
Mailing Address - Fax:786-801-0165
Practice Address - Street 1:13155 SW 42ND ST STE 111112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3428
Practice Address - Country:US
Practice Address - Phone:305-960-7668
Practice Address - Fax:786-801-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization