Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1134499098 |
---|---|
Provider Name | Mr. Mark Daniel Guerra |
First Address | Corpus Christi, TX 78411-2736 |
Second Address | Corpus Christi, TX 78411-2736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2012 |
Last Update Date | 10/01/2012 |