Provider Demographics
NPI:1184777237
Name:ALFARERO, GUILLERMA TAMARRA (LVN)
Entity type:Individual
Prefix:
First Name:GUILLERMA
Middle Name:TAMARRA
Last Name:ALFARERO
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 1:6281 N MALSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0957
Mailing Address - Country:US
Mailing Address - Phone:559-435-5732
Mailing Address - Fax:
Practice Address - Street 1:5070 E BELGRAVIA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-1239
Practice Address - Country:US
Practice Address - Phone:559-255-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA169414164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN002500Medicaid
CAEPS011420Medicaid