Provider Demographics
NPI:1699428235
Name:GUERRA SOSA, CARMEN (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:GUERRA SOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W ROYAL PALM RD APT 1036
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-9314
Mailing Address - Country:US
Mailing Address - Phone:601-307-0047
Mailing Address - Fax:
Practice Address - Street 1:9169 W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-2942
Practice Address - Country:US
Practice Address - Phone:602-283-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR79112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine