Provider Demographics
NPI:1972596963
Name:GUERRERO, VICTOR MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:430 S BLOSSER RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4908
Practice Address - Country:US
Practice Address - Phone:805-361-8900
Practice Address - Fax:805-361-8990
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-06-29
Deactivation Date:2013-02-05
Deactivation Code:
Reactivation Date:2013-03-21
Provider Licenses
StateLicense IDTaxonomies
CAA50302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB218840OtherMEDICARE ID
CA200507Medicaid
080142826OtherRAILROAD-MEDICARE
A50302Medicare ID - Type Unspecified