Provider Demographics
NPI:1720752306
Name:GUERRA, RAUL ESTUARDO (OTR/L)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:ESTUARDO
Last Name:GUERRA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 W POINSETTIA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2515
Mailing Address - Country:US
Mailing Address - Phone:310-946-6324
Mailing Address - Fax:
Practice Address - Street 1:20625 N LAKE PLEASANT RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9704
Practice Address - Country:US
Practice Address - Phone:623-566-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-008141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist