Provider Demographics
NPI:1912782822
Name:AGUERO, MARIO JR (RAC)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:AGUERO
Suffix:JR
Gender:M
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 N VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-3419
Mailing Address - Country:US
Mailing Address - Phone:559-547-9819
Mailing Address - Fax:559-498-0507
Practice Address - Street 1:539 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3419
Practice Address - Country:US
Practice Address - Phone:559-547-9819
Practice Address - Fax:559-498-0507
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16167101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty