Provider Demographics
NPI:1124476817
Name:JOSE GUERRA MD & ASSOCIATES LLC
Entity type:Organization
Organization Name:JOSE GUERRA MD & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ARMANDO
Authorized Official - Last Name:GUERRA-VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-514-2450
Mailing Address - Street 1:6001 SW 70TH ST APT 347
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3426
Mailing Address - Country:US
Mailing Address - Phone:786-514-2450
Mailing Address - Fax:
Practice Address - Street 1:6001 SW 70TH ST APT 347
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:786-514-2450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121917261QM0850X, 323P00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014195400Medicaid
FLID902ZOtherMEDICAID PTAN