Healthcare Provider Details

I. General information

NPI: 1477316263
Provider Name (Legal Business Name): GUILLERMO URETA CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MEMO URETA NA

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 GLIDER AVE
HESPERIA CA
92345-5752
US

IV. Provider business mailing address

7611 GLIDER AVE
HESPERIA CA
92345-5752
US

V. Phone/Fax

Practice location:
  • Phone: 760-885-6923
  • Fax:
Mailing address:
  • Phone: 760-885-6923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number71469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: