1588440358 NPI number — CARLOS ALBERTO GUERRERO VALDEZ

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588440358 NPI number — CARLOS ALBERTO GUERRERO VALDEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLOS ALBERTO GUERRERO VALDEZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1588440358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1983 S MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-349-6409
Provider Business Mailing Address Fax Number:
619-354-2449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 Y 34 COLONIA ALTAR AV NUEVO LEON A CENTRE CALLES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS RIO COLORADO
Provider Business Practice Location Address State Name:
SONORA
Provider Business Practice Location Address Postal Code:
83490
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
619-349-6409
Provider Business Practice Location Address Fax Number:
619-354-2449
Provider Enumeration Date:
09/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GUERRERO VALDEZ
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
ALBERTO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-349-6409

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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