Provider Demographics
NPI:1922768985
Name:GUERRERO, MARINA IVON
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:IVON
Last Name:GUERRERO
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 1:31946 MISSION TRL STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4539
Mailing Address - Country:US
Mailing Address - Phone:951-245-7663
Mailing Address - Fax:
Practice Address - Street 1:2560 N PERRIS BLVD STE N1
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3251
Practice Address - Country:US
Practice Address - Phone:951-940-6755
Practice Address - Fax:951-210-1240
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker