Basic Information
| Provider Information | |||||||||
| NPI: | 1376643296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUERRA | ||||||||
| FirstName: | HORACE | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GUERRA | ||||||||
| OtherFirstName: | HORACIO | ||||||||
| OtherMiddleName: | PAUL | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | IV | ||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 3299 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897023299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752220044 | ||||||||
| FaxNumber: | 8887000187 | ||||||||
| Practice Location | |||||||||
| Address1: | 7391 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891171577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023042144 | ||||||||
| FaxNumber: | 7023042147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207Q00000X | 11608 | NV | N | Allopathic & Osteopathic Physicians | Family Medicine | 2083P0011X | 11608 | NV | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | 208M00000X | 11608 | NV | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 6826335-1205 | UT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1376643296 | 05 | NV | MEDICAID |