Provider Demographics
NPI:1487945218
Name:GUERRERO ARMENTA, ULISES G
Entity type:Individual
Prefix:
First Name:ULISES
Middle Name:G
Last Name:GUERRERO ARMENTA
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 1:45561 OASIS ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4372
Mailing Address - Country:US
Mailing Address - Phone:760-347-9807
Mailing Address - Fax:760-775-6353
Practice Address - Street 1:45561 OASIS ST
Practice Address - Street 2:STE. 103
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4372
Practice Address - Country:US
Practice Address - Phone:760-347-9807
Practice Address - Fax:760-775-6353
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2749984343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)