Basic Information
| Provider Information | |||||||||
| NPI: | 1245635853 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARIO SALGUERO INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1770 | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919441770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194641165 | ||||||||
| FaxNumber: | 6195671011 | ||||||||
| Practice Location | |||||||||
| Address1: | 11858 BERNARDO PLAZA CT | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921282439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584611142 | ||||||||
| FaxNumber: | 8889653536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2014 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | SALGUERO GALLAND | ||||||||
| AuthorizedOfficialFirstName: | MARIO LUIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8584611142 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A122101 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.