Provider Demographics
NPI:1740089978
Name:GUERRERO, MIRACLE TRAVON
Entity type:Individual
Prefix:
First Name:MIRACLE
Middle Name:TRAVON
Last Name:GUERRERO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W MONROE AVE APT 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2960
Mailing Address - Country:US
Mailing Address - Phone:702-292-2052
Mailing Address - Fax:
Practice Address - Street 1:1100 W MONROE AVE APT 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2960
Practice Address - Country:US
Practice Address - Phone:702-292-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant