1528783040 NPI number — MARIA GUADALUPE GONZALEZ GUERRERO BA

Table of content: MARIA GUADALUPE GONZALEZ GUERRERO BA (NPI 1528783040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528783040 NPI number — MARIA GUADALUPE GONZALEZ GUERRERO BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ GUERRERO
Provider First Name:
MARIA
Provider Middle Name:
GUADALUPE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA
Provider Gender Code:
F

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:
1528783040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2730 SHADELANDS DR BLDG 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1670 CORPORATE CIR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PETALUMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94954-6947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-308-2121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2022

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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