Provider Demographics
NPI:1629842356
Name:DORADO, GUILLERMO ROBLES JR
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:ROBLES
Last Name:DORADO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 EL CERRITO WAY APT A
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4048
Mailing Address - Country:US
Mailing Address - Phone:559-705-3772
Mailing Address - Fax:
Practice Address - Street 1:1530 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5350
Practice Address - Country:US
Practice Address - Phone:628-250-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician