Provider Demographics
NPI:1255196127
Name:GUERRERO-HEREDIA, PAULINA (BA)
Entity type:Individual
Prefix:MS
First Name:PAULINA
Middle Name:
Last Name:GUERRERO-HEREDIA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FULTON AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1354
Mailing Address - Country:US
Mailing Address - Phone:747-253-1973
Mailing Address - Fax:
Practice Address - Street 1:6545 FULTON AVE APT 206
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1354
Practice Address - Country:US
Practice Address - Phone:747-253-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner