Provider Demographics
NPI:1447281183
Name:GUERRERO, ETHEL JOSE (DDS)
Entity type:Individual
Prefix:DR
First Name:ETHEL
Middle Name:JOSE
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35436 BRETON DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1709
Mailing Address - Country:US
Mailing Address - Phone:510-304-4495
Mailing Address - Fax:510-818-0503
Practice Address - Street 1:35436 BRETON DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1709
Practice Address - Country:US
Practice Address - Phone:510-304-4495
Practice Address - Fax:510-818-0503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48113OtherCA DENTAL LICENSE NUMBER