Provider Demographics
NPI:1922488592
Name:GUERRA, ANNETTE (LSA)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:BUITRAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFSA
Mailing Address - Street 1:18444 N 25TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:866-974-2673
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:18444 N 25TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-1266
Practice Address - Country:US
Practice Address - Phone:866-974-2673
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA000587246ZC0007X
TX157449246ZC0007X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant