Provider Demographics
NPI:1235490004
Name:GUERRERO, MARIO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
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 1:1900 COVINA DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2971
Mailing Address - Country:US
Mailing Address - Phone:650-520-5402
Mailing Address - Fax:775-420-5396
Practice Address - Street 1:1900 COVINA DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2971
Practice Address - Country:US
Practice Address - Phone:650-520-5402
Practice Address - Fax:775-420-5396
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst