Provider Demographics
NPI:1457695736
Name:DELA GUERRA, DE WAYNE D (LVN)
Entity Type:Individual
Prefix:MR
First Name:DE WAYNE
Middle Name:D
Last Name:DELA GUERRA
Suffix:
Gender:M
Credentials:LVN
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 74654
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-0654
Mailing Address - Country:US
Mailing Address - Phone:619-793-9848
Mailing Address - Fax:323-417-4865
Practice Address - Street 1:928 N WESTERN AVE APT 306
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3872
Practice Address - Country:US
Practice Address - Phone:619-793-9848
Practice Address - Fax:323-544-0899
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALPN02498164W00000X
CA240-636164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse