Provider Demographics
NPI:1902904998
Name:GUERRA, VENUSTIANO JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:VENUSTIANO
Middle Name:JAVIER
Last Name:GUERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 3RD AVE
Mailing Address - Street 2:STE E
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5882
Mailing Address - Country:US
Mailing Address - Phone:619-427-4300
Mailing Address - Fax:619-427-4301
Practice Address - Street 1:1635 3RD AVE
Practice Address - Street 2:STE E
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5882
Practice Address - Country:US
Practice Address - Phone:619-427-4300
Practice Address - Fax:619-427-4301
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53771208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537710OtherBLUE CROSS
CA00A537711Medicaid
CA00A537711Medicaid
CAA53771Medicare ID - Type Unspecified