Basic Information
| Provider Information | |||||||||
| NPI: | 1255371761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUERREIRO | ||||||||
| FirstName: | SERGIO | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 862 LEMONGRASS LN | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334148254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614962082 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7431 W ATLANTIC AVE | ||||||||
| Address2: | SUITE 53-56 | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334463512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614962082 | ||||||||
| FaxNumber: | 5614964448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AY1086 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 40007057 | 01 | FL | PEDIATRIC ASSOCIATES | OTHER | 600332000 | 05 | FL | MEDICAID | 4899807 | 01 | FL | GHI | OTHER |