Provider Demographics
NPI:1669777835
Name:JAMES S. GUERRERO PLLC
Entity type:Organization
Organization Name:JAMES S. GUERRERO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-842-0883
Mailing Address - Street 1:5151 EDINA INDUSTRIAL BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3013
Mailing Address - Country:US
Mailing Address - Phone:952-842-0883
Mailing Address - Fax:
Practice Address - Street 1:5151 EDINA INDUSTRIAL BLVD
Practice Address - Street 2:STE 110
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3013
Practice Address - Country:US
Practice Address - Phone:952-842-0883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN26D16GUOtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
MN260001771OtherMEDICARE PROVIDER NUMBER
MN533283400Medicaid
MN260001771OtherMEDICARE PROVIDER NUMBER