Provider Demographics
NPI:1508584962
Name:GUERRERO, MARI ELIZABETH-HISAMOTO
Entity Type:Individual
Prefix:MRS
First Name:MARI
Middle Name:ELIZABETH-HISAMOTO
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARI
Other - Middle Name:ELIZABETH-HISAMOTO
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5800 SHADOWBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3053
Mailing Address - Country:US
Mailing Address - Phone:916-224-0001
Mailing Address - Fax:
Practice Address - Street 1:3555 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2071
Practice Address - Country:US
Practice Address - Phone:916-482-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program