Provider Demographics
NPI:1750365136
Name:GUERRA, ANSELMO A (CRNA)
Entity type:Individual
Prefix:
First Name:ANSELMO
Middle Name:A
Last Name:GUERRA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E WHEATLAND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4914
Mailing Address - Country:US
Mailing Address - Phone:972-283-0063
Mailing Address - Fax:972-283-0284
Practice Address - Street 1:7992 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3764
Practice Address - Country:US
Practice Address - Phone:972-283-2400
Practice Address - Fax:972-283-0999
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX431182367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130118607Medicaid
TX130118607Medicaid