Provider Demographics
NPI:1720677420
Name:GUERRA, PEDRO (NP-C)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:GUERRA
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W JOHN CARPENTER FWY STE 420
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2014
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:
Practice Address - Street 1:2636 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6485
Practice Address - Country:US
Practice Address - Phone:972-487-5800
Practice Address - Fax:972-487-9682
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10201299363L00000X
TX1020160363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner