Healthcare Provider Details

I. General information

NPI: 1205953270
Provider Name (Legal Business Name): MARIAH L. GUERRA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD ROOM 200
SALINAS CA
93906-3122
US

IV. Provider business mailing address

1327 GRANDHAVEN ST
SALINAS CA
93905-2421
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-1700
  • Fax: 831-769-0552
Mailing address:
  • Phone: 831-796-1700
  • Fax: 831-769-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN213993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: