Provider Demographics
NPI:1841865169
Name:GUERRERO, STEPHANIA
Entity type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIA
Other - Middle Name:
Other - Last Name:POLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:434 LUNA BELLA LN APT 375
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-4529
Mailing Address - Country:US
Mailing Address - Phone:201-952-3226
Mailing Address - Fax:
Practice Address - Street 1:434 LUNA BELLA LN APT 375
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-4529
Practice Address - Country:US
Practice Address - Phone:201-952-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL97173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist