Provider Demographics
NPI:1942621289
Name:CEA, MARIO FRANCISCO (RW7269)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:FRANCISCO
Last Name:CEA
Suffix:
Gender:M
Credentials:RW7269
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E. 17TH STREET, SUITE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-542-0400
Mailing Address - Fax:714-542-0404
Practice Address - Street 1:1525 E. 17TH STREET
Practice Address - Street 2:SUIT, B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-542-0400
Practice Address - Fax:714-542-0404
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW7269101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)