Provider Demographics
NPI:1639604341
Name:GUERRERO, IAN (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:GUERRERO
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 1:840 KAKALA ST APT 405
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4608
Mailing Address - Country:US
Mailing Address - Phone:520-999-0041
Mailing Address - Fax:
Practice Address - Street 1:91-710 FARRINGTON HWY STE A120
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2659
Practice Address - Country:US
Practice Address - Phone:808-400-3899
Practice Address - Fax:808-512-2122
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI21171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine