Provider Demographics
NPI:1932302221
Name:GUERRERO, MARY ELENA (LVN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELENA
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 LASSEN AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-5932
Mailing Address - Country:US
Mailing Address - Phone:209-541-5602
Mailing Address - Fax:
Practice Address - Street 1:1536 LASSEN AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-5932
Practice Address - Country:US
Practice Address - Phone:209-541-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 167840164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS016590OtherMEDICAL