1114064730 NPI number — CARLOS ALFREDO GUERRERO ROSAS LCSW

Table of content: CARLOS ALFREDO GUERRERO ROSAS LCSW (NPI 1114064730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114064730 NPI number — CARLOS ALFREDO GUERRERO ROSAS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERRERO ROSAS
Provider First Name:
CARLOS
Provider Middle Name:
ALFREDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114064730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 52ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94609-1809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-428-3885
Provider Business Mailing Address Fax Number:
510-238-9764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 CLAY ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-3885
Provider Business Practice Location Address Fax Number:
510-238-9764
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW 66163 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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