Provider Demographics
NPI:1518053503
Name:GUERRERO, ISMAEL INCLAN (MD)
Entity type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:INCLAN
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ISMAEL
Other - Middle Name:INCLAN
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1881 W 24TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6298
Mailing Address - Country:US
Mailing Address - Phone:928-726-7171
Mailing Address - Fax:928-726-7206
Practice Address - Street 1:1881 W 24TH ST STE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6298
Practice Address - Country:US
Practice Address - Phone:928-726-7171
Practice Address - Fax:928-726-7206
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21545207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ139841 001Medicaid
AZA89964Medicare UPIN
AZZ82392Medicare PIN