Basic Information
| Provider Information | |||||||||
| NPI: | 1427215813 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARLOS GUERRA JR MD PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARLOS GUERRA JR MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9701 RICHMOND | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138407956 | ||||||||
| FaxNumber: | 7138407957 | ||||||||
| Practice Location | |||||||||
| Address1: | 9701 RICHMOND | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138407956 | ||||||||
| FaxNumber: | 7138407957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GUERRA | ||||||||
| AuthorizedOfficialFirstName: | CARLOS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7138407956 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | H8094 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 4632139 | 01 | TX | AETNA | OTHER | 8B4250 | 01 | TX | BCBS | OTHER | P1822411 | 01 | TX | OXFORD UNITED BEHAVIORAL HEALTH | OTHER | 10016364 | 05 | TX | MEDICAID | 022235 | 01 | TX | VALUE OPTIONS | OTHER | 115402302 | 05 | TX | MEDICAID | 699552 | 01 | TX | COMPSYCH | OTHER |