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General NPI Number Information
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NPI Number | 1053557942
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Entity Type | Organization
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Legal Business Name | MARIEL GUERRA, JR
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 1101 E DALLAS AVE STE 2
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City | MCALLEN
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State | TX
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Zip | 78501
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Country | US
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Telephone | 956-994-3111
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Fax | 956-994-3336
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Provider Business Mailing Address
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Address Line | 1101 E DALLAS AVE STE 2
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City | MCALLEN
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State | TX
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Zip | 78501
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Country | US
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Telephone | 956-994-3111
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Fax | 956-994-3336
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Authorized Official
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Title or Position | OWNER
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Name | MARIEL GUERRA JR.
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Credential |
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Telephone | 956-994-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State | TX
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