Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 25MA05950700 | NJ |
N | 2080A0000X | Adolescent Medicine | MA057052 | NJ |
NPI | 1154432276 |
---|---|
Provider Name | Julio C Guerra |
First Address | Randolph, NJ 07869-1925 |
Second Address | Randolph, NJ 07869-1925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 22/05/2012 |