Provider Demographics
NPI:1962188268
Name:GUERRA, AILYN
Entity type:Individual
Prefix:
First Name:AILYN
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 NW 133RD TER UNIT 302
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-7681
Mailing Address - Country:US
Mailing Address - Phone:786-913-8292
Mailing Address - Fax:
Practice Address - Street 1:104 NW 133RD TER UNIT 302
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-7681
Practice Address - Country:US
Practice Address - Phone:786-913-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-280473106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician