Provider Demographics
NPI:1053557942
Name:MARIEL GUERRA, JR
Entity type:Organization
Organization Name:MARIEL GUERRA, JR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-994-3111
Mailing Address - Street 1:1101 E DALLAS AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501
Mailing Address - Country:US
Mailing Address - Phone:956-994-3111
Mailing Address - Fax:956-994-3336
Practice Address - Street 1:1101 E DALLAS AVE
Practice Address - Street 2:STE 2
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-994-3111
Practice Address - Fax:956-994-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6251900001Medicare NSC