Provider Demographics
NPI:1831556497
Name:GUERRA, JOAQUIN
Entity type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:
Last Name:GUERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 FUTURES DR
Mailing Address - Street 2:#150,104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9095
Mailing Address - Country:US
Mailing Address - Phone:407-730-7983
Mailing Address - Fax:407-985-3678
Practice Address - Street 1:7550 FUTURES DR
Practice Address - Street 2:#150,104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9095
Practice Address - Country:US
Practice Address - Phone:407-730-7983
Practice Address - Fax:407-985-3678
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health