Provider Demographics
NPI:1316816275
Name:GUERRERO ORTIZ, EDGAR ALONSO
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:ALONSO
Last Name:GUERRERO ORTIZ
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 1:701 CURTNER AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2057
Mailing Address - Country:US
Mailing Address - Phone:707-405-6610
Mailing Address - Fax:
Practice Address - Street 1:701 CURTNER AVE APT 305
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2057
Practice Address - Country:US
Practice Address - Phone:707-405-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner