Provider Demographics
NPI:1093160319
Name:NERIA, GUADALUPE ANGELINA
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:ANGELINA
Last Name:NERIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 FREEDOM ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-7386
Mailing Address - Country:US
Mailing Address - Phone:909-810-7664
Mailing Address - Fax:
Practice Address - Street 1:1410 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4440
Practice Address - Country:US
Practice Address - Phone:559-784-5483
Practice Address - Fax:559-784-5433
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159637207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine