Provider Demographics
NPI:1730953985
Name:GUERRERO, CAROLYN CAMILLE (OTR)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:CAMILLE
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2849 CARMAR WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3849
Mailing Address - Country:US
Mailing Address - Phone:619-772-6216
Mailing Address - Fax:
Practice Address - Street 1:8996 MIRAMAR RD STE 315
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4463
Practice Address - Country:US
Practice Address - Phone:619-818-6873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25685225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist