Provider Demographics
NPI:1134499098
Name:GUERRA, MARK DANIEL
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DANIEL
Last Name:GUERRA
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 1:4707 EVERHART RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2736
Mailing Address - Country:US
Mailing Address - Phone:361-225-2695
Mailing Address - Fax:
Practice Address - Street 1:4707 EVERHART RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2736
Practice Address - Country:US
Practice Address - Phone:361-225-2695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician