Provider Demographics
NPI:1265736326
Name:GUERECA, PATRICIA (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GUERECA
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6952
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-8094
Mailing Address - Country:US
Mailing Address - Phone:575-758-5859
Mailing Address - Fax:575-758-2832
Practice Address - Street 1:220 4TH AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2643
Practice Address - Country:US
Practice Address - Phone:575-374-2032
Practice Address - Fax:575-374-0158
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator