Provider Demographics
NPI:1225585862
Name:GUDINO, ADRIAN
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:
Last Name:GUDINO
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 1:6430 VERNER AVE
Mailing Address - Street 2:APT 184
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841
Mailing Address - Country:US
Mailing Address - Phone:623-692-6736
Mailing Address - Fax:
Practice Address - Street 1:5151 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6304
Practice Address - Country:US
Practice Address - Phone:623-692-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136210183700000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No183700000XPharmacy Service ProvidersPharmacy Technician