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Justin Andrew De La Guerra

Family Medicine

Allopathic & Osteopathic Physicians

1601 Owen Dr, Fayetteville, NC 28304-3425

PECOS Enrollment

This provider is enrolled in PECOS as JUSTIN DE LA GUERRA.

Based on the most recent information from CMS, provider Justin Andrew De La Guerra is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1164009585
Provider Type
Individual
Full Name
De La Guerra, Justin Andrew
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
3/24/2021
Last Updated
6/26/2024

Contact Information

Practice Location

1601 Owen Dr, Fayetteville, NC 28304-3425

(910) 678-7259

Unlisted Fax

Mailing Location

1601 Owen Dr, Fayetteville, NC 28304-3425

(910) 678-0100

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 2023-02662 North Carolina

Justin Andrew De La Guerra

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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