Provider Demographics
NPI:1457816852
Name:GUERRERO, NEDALEE (RBT)
Entity Type:Individual
Prefix:
First Name:NEDALEE
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 PREMIER DR STE 234
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2693
Mailing Address - Country:US
Mailing Address - Phone:940-300-7606
Mailing Address - Fax:
Practice Address - Street 1:3100 PREMIER DR STE 234
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2693
Practice Address - Country:US
Practice Address - Phone:940-300-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-18-62943247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-18-62943OtherBACB