Provider Demographics
NPI:1144352139
Name:GUERRERO, WALDO S (PA)
Entity type:Individual
Prefix:MR
First Name:WALDO
Middle Name:S
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 DONALD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4019
Mailing Address - Country:US
Mailing Address - Phone:813-935-1475
Mailing Address - Fax:
Practice Address - Street 1:4600 N HABANA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7166
Practice Address - Country:US
Practice Address - Phone:813-879-4477
Practice Address - Fax:813-879-4467
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant