Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | 004647-1 | NY |
NPI | 1265622120 |
---|---|
Provider Name | John Guerra |
First Address | New York, NY 10011-1605 |
Second Address | New York, NY 10011-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 26/07/2007 |