Provider Demographics
NPI:1295334548
Name:GUADALUPE ANGELINA NERIA MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GUADALUPE ANGELINA NERIA MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:ANGELINA
Authorized Official - Last Name:NERIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-810-7664
Mailing Address - Street 1:222 W HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1731
Mailing Address - Country:US
Mailing Address - Phone:559-784-5483
Mailing Address - Fax:
Practice Address - Street 1:222 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1731
Practice Address - Country:US
Practice Address - Phone:559-784-5483
Practice Address - Fax:559-789-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service