Provider Demographics
NPI:1336272855
Name:GUERRERO, ALFREDO JOEL (OT)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:JOEL
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 N IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2329
Mailing Address - Country:US
Mailing Address - Phone:760-353-3422
Mailing Address - Fax:
Practice Address - Street 1:428 N IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2329
Practice Address - Country:US
Practice Address - Phone:760-353-3422
Practice Address - Fax:760-353-9163
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 9247225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT9247AMedicare PIN