Provider Demographics
NPI:1205953270
Name:GUERRA, MARIAH L (LVN)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:L
Last Name:GUERRA
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 1:1327 GRANDHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2421
Mailing Address - Country:US
Mailing Address - Phone:831-796-1700
Mailing Address - Fax:831-769-0552
Practice Address - Street 1:1270 NATIVIDAD RD
Practice Address - Street 2:ROOM 200
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3122
Practice Address - Country:US
Practice Address - Phone:831-796-1700
Practice Address - Fax:831-769-0552
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN213993164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN213993OtherLICENSED VOCATIONAL NURSE