Provider Demographics
NPI:1295902070
Name:LISA E. GUERRA, M.D., INC
Entity type:Organization
Organization Name:LISA E. GUERRA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-764-8281
Mailing Address - Street 1:17501 17TH ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7902
Mailing Address - Country:US
Mailing Address - Phone:949-764-8281
Mailing Address - Fax:949-764-8236
Practice Address - Street 1:ONE HOAG DR., HOAG BREAST CENTER
Practice Address - Street 2:SUE AND BILL GROSS WOMEN'S PAVILION
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-8281
Practice Address - Fax:949-764-8236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95743208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ630BOtherMEDICARE PTAN
CAI59181Medicare UPIN