Provider Demographics
NPI:1568545325
Name:JAUREGUI, MARIO ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ALBERT
Last Name:JAUREGUI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1261 EVERGREEN ROAD
Practice Address - Street 2:
Practice Address - City:WRIGHTWOOD
Practice Address - State:CA
Practice Address - Zip Code:92397-0445
Practice Address - Country:US
Practice Address - Phone:760-249-6877
Practice Address - Fax:760-249-6377
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC28246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28246OtherCHIROPRACTIC LICENSE
CAZZZ03115ZMedicare PIN
CAVO7169Medicare UPIN