Provider Demographics
NPI:1811108491
Name:GUERRERO, JORGE A (PA-C)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SW 42ND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1938
Mailing Address - Country:US
Mailing Address - Phone:305-443-4493
Mailing Address - Fax:305-443-4496
Practice Address - Street 1:401 SW 42ND AVE
Practice Address - Street 2:STE 200
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1938
Practice Address - Country:US
Practice Address - Phone:305-443-4493
Practice Address - Fax:305-443-4496
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001833363A00000X
FLPA9104178363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI414ZOtherMEDICARE
FL2929716 00Medicaid
VA010253926Medicaid