Provider Demographics
NPI:1124102728
Name:GUERRERO, JOSE RAFAEL SR (OD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAFAEL
Last Name:GUERRERO
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE MENDEZ VIGO
Mailing Address - Street 2:#331
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-796-1265
Mailing Address - Fax:787-796-1265
Practice Address - Street 1:CALLE MENDEZ VIGO
Practice Address - Street 2:#331
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-796-1265
Practice Address - Fax:787-796-1265
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49913Medicare UPIN
PR58239Medicare ID - Type Unspecified