Provider Demographics
NPI:1447375001
Name:GUERRA, JORGE A (LDO)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:A
Last Name:GUERRA
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-7431
Mailing Address - Country:US
Mailing Address - Phone:305-549-7333
Mailing Address - Fax:305-549-7339
Practice Address - Street 1:1869 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7431
Practice Address - Country:US
Practice Address - Phone:305-549-7333
Practice Address - Fax:305-549-7339
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4033156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician