Provider Demographics
NPI:1568972677
Name:MARIO F. AGUERO M.
Entity Type:Organization
Organization Name:MARIO F. AGUERO M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:AGUERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-886-8558
Mailing Address - Street 1:109 HEFFERNAN AVE. PMB 81-064
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:82231-2735
Mailing Address - Country:US
Mailing Address - Phone:760-886-8558
Mailing Address - Fax:858-430-3143
Practice Address - Street 1:AV. FRANCISCO I. MADERO #1268-A
Practice Address - Street 2:
Practice Address - City:MEXICALI
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21100
Practice Address - Country:MX
Practice Address - Phone:760-886-8558
Practice Address - Fax:858-430-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ99192721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty