Provider Demographics
NPI:1184323792
Name:GUERRERO, PERRY SCOTT (C,P,C)
Entity type:Individual
Prefix:MR
First Name:PERRY
Middle Name:SCOTT
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:C,P,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 AUBURN WAY N.
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1805
Mailing Address - Country:US
Mailing Address - Phone:253-999-5750
Mailing Address - Fax:253-999-5740
Practice Address - Street 1:3320 AUBURN WAY N.
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1805
Practice Address - Country:US
Practice Address - Phone:253-999-5750
Practice Address - Fax:253-999-5740
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61417611175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG61417611Medicaid
WA1326502865Medicaid