Provider Demographics
NPI:1871059154
Name:GUERRA, JESSICA ANGELINA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANGELINA
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 1:2261 VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4377
Mailing Address - Country:US
Mailing Address - Phone:559-596-4389
Mailing Address - Fax:
Practice Address - Street 1:2261 VILLA AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4377
Practice Address - Country:US
Practice Address - Phone:559-596-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA96792492D66138Medicaid