Healthcare Provider Details

I. General information

NPI: 1578170163
Provider Name (Legal Business Name): MARCO ANTONIO GUDINO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 ALAMO DR STE B
VACAVILLE CA
95687-6583
US

IV. Provider business mailing address

1490 ALAMO DR STE B
VACAVILLE CA
95687-6583
US

V. Phone/Fax

Practice location:
  • Phone: 707-474-5688
  • Fax:
Mailing address:
  • Phone: 707-474-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: