Provider Demographics
NPI:1063677615
Name:GUERRERO, ALBERTO AXAYACATL
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:AXAYACATL
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39275 LIBERTY ST STE D12
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1519
Mailing Address - Country:US
Mailing Address - Phone:510-742-3904
Mailing Address - Fax:510-742-3912
Practice Address - Street 1:39275 LIBERTY ST STE D12
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1519
Practice Address - Country:US
Practice Address - Phone:510-742-3904
Practice Address - Fax:510-742-3912
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor