Provider Demographics
NPI:1659797108
Name:GUERIN, ELYSE NICHOLE
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:NICHOLE
Last Name:GUERIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 BELLOMY ST
Mailing Address - Street 2:APT 17
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5772
Mailing Address - Country:US
Mailing Address - Phone:510-472-8005
Mailing Address - Fax:
Practice Address - Street 1:1962 BELLOMY ST
Practice Address - Street 2:APT 17
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5772
Practice Address - Country:US
Practice Address - Phone:510-472-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator