Provider Demographics
NPI:1578170163
Name:GUDINO, MARCO ANTONIO (DC)
Entity Type:Individual
Prefix:
First Name:MARCO ANTONIO
Middle Name:
Last Name:GUDINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 BALFOUR RD STE D
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1515
Mailing Address - Country:US
Mailing Address - Phone:925-308-7575
Mailing Address - Fax:
Practice Address - Street 1:4550 BALFOUR RD STE D
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1515
Practice Address - Country:US
Practice Address - Phone:925-308-7575
Practice Address - Fax:925-240-7878
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor