Provider Demographics
NPI:1669012290
Name:DUENAS, DAVID GUERRERO (BA/LICENCIATURA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GUERRERO
Last Name:DUENAS
Suffix:
Gender:M
Credentials:BA/LICENCIATURA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 PAULIN AVE
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-5107
Mailing Address - Country:US
Mailing Address - Phone:760-909-5113
Mailing Address - Fax:
Practice Address - Street 1:1603 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2212
Practice Address - Country:US
Practice Address - Phone:760-679-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician