Provider Demographics
NPI:1093130189
Name:GUERARD, MARY (LAC AC3313)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:GUERARD
Suffix:
Gender:F
Credentials:LAC AC3313
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 OLD REDWOOD HWY., SUITE 1C
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-546-1225
Mailing Address - Fax:707-546-1225
Practice Address - Street 1:4701 OLD REDWOOD HWY., SUITE 1C
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-546-1225
Practice Address - Fax:707-546-1225
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3313171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist