Provider Demographics
NPI:1245527639
Name:GUERRERO, CRYSTAL M
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:M
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3114
Mailing Address - Country:US
Mailing Address - Phone:323-235-6752
Mailing Address - Fax:
Practice Address - Street 1:5850 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-1215
Practice Address - Country:US
Practice Address - Phone:323-235-6752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator